• Machine learning predictive system based upon radiodensitometric distributions from mid-thigh CT images.

      Recenti, Marco; Ricciardi, Carlo; Edmunds, Kyle; Gislason, Magnus K; Gargiulo, Paolo; 1Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland. 2Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy. 3Department of Science, Landspítali, Reykjavík, Iceland. (PAGEPRESS PUBL, 2020-04-01)
      The nonlinear trimodal regression analysis (NTRA) method based on radiodensitometric CT images distributions was developed for the quantitative characterization of soft tissue changes according to the lower extremity function of elderly subjects. In this regard, the NTRA method defines 11 subject-specific soft tissue parameters and has illustrated high sensitivity to changes in skeletal muscle form and function. The present work further explores the use of these 11 NTRA parameters in the construction of a machine learning (ML) system to predict body mass index and isometric leg strength using tree-based regression algorithms. Results obtained from these models demonstrate that when using an ML approach, these soft tissue features have a significant predictive value for these physiological parameters. These results further support the use of NTRA-based ML predictive assessment and support the future investigation of other physiological parameters and comorbidities. Keywords: Computed Tomography; Machine learning; body mass index; isometric leg strength; soft tissue.
    • Macular corneal dystrophy in Iceland. A clinical, genealogic, and immunohistochemical study of 28 patients

      Jonasson, F; Oshima, E; Thonar, E J; Smith, C F; Johannsson, J H; Klintworth, G K; University Department of Ophthalmology, Landakot Hospital, Reykjavik, Iceland. (Elsevier, 1996-07-01)
      BACKGROUND: The frequency of different types of macular corneal dystrophy (MCD) was determined in Iceland where MCD accounts for one third of every penetrating keratoplasty. METHODS: The authors determined the serum levels of antigenic keratan sulfate (aKS) in 27 patients with MCD and 53 unaffected family members by an enzyme-linked immunosorbent assay that uses an anti-KS monoclonal antibody (5-D-4). The authors also stained sections from 37 corneal buttons (including 2 regrafts) from 23 patients with MCD by the avidin-biotin complex method using the same anti-KS monoclonal antibody. RESULTS: Based on the serum analyses, 22 patients had MCD type I and 5 had MCD type II. The corneas from patients without detectable KS in the serum lacked immunohistochemical reactivity to the anti-KS antibody. Every MCD cornea examined from individuals with normal serum KS levels showed KS reactivity. All 53 unaffected siblings and parents carrying the recessive gene had normal serum KS levels. CONCLUSIONS: Macular corneal dystrophy types I (78.6%) and II (21.4%) both occur in Iceland. Members of affected sibships had only one of these types, not both. Nine patients with MCD type I and four persons with MCD type II belonged to a large pedigree in which individuals have been traced as far back as the beginning of the 16th century. The linking of patients with MCD types I and II in an inbred pedigree suggests that both types may be manifestations of the same abnormal gene rather than independent entities. The serum KS levels were not helpful in detecting heterozygous MCD carriers.
    • Macular corneal dystrophy types I and II are caused by distinct mutations in the CHST6 gene in Iceland.

      Liu, Ning-Pu; Smith, Clayton F; Bowling, Brandy L; Jonasson, Fridbert; Klintworth, Gordon K (Molecular Vision, 2006-10-02)
      PURPOSE: To identify CHST6 mutations in five additional Icelandic cases of macular corneal dystrophy (MCD) type I and in four families with MCD type II from Iceland. METHODS: Genomic DNA was extracted from blood leukocytes of patients with MCD, their healthy family members, and from control individuals. CHST6 mutations were determined by PCR-sequencing. Immunophenotypes of MCD were determined by measuring antigenic keratan sulfate (AgKS) levels in serum and by an immunohistochemical study on corneal tissue. RESULTS: Five additional cases of MCD type I and four families with MCD type II from Iceland were studied. A homozygous p.A128V mutation in the coding region of the CHST6 gene was identified in four of the five MCD type I cases. The other person with MCD type I was a compound heterozygote for p.A128V and a frameshift p.V6fs resulting from a 10-base pair insertion (c.15_16insATGCTGTGCG). Four of five individuals with MCD type II were compound heterozygotes for p.A128V and p.V329L, thus sharing the same p.A128V mutation as MCD type I. One patient with MCD type II was homozygous for p.V329L. The p.V329L mutation was only found in MCD type II patients. An analysis of the upstream region of CHST6 disclosed no upstream deletion or replacements in Icelandic patients with MCD type II. CONCLUSIONS: The findings fit the haplotype analysis that we reported previously in Icelandic MCD families and indicate that different mutations in CHST6 cause MCD type I and type II in Iceland.
    • Magnetization transfer imaging, white matter hyperintensities, brain atrophy and slower gait in older men and women

      Rosano, Caterina; Sigurdsson, Sigurdur; Siggeirsdottir, Kristin; Phillips, Caroline L; Garcia, Melissa; Jonsson, Palmi V; Eiriksdottir, Gudny; Newman, Anne B; Harris, Tamara B; van Buchem, Mark A; et al. (2010-07-01)
      OBJECTIVE: To assess whether markers of micro- and macrostructural brain abnormalities are associated with slower gait in older men and women independent of each other, and also independent of health-related conditions and of behavioral, cognitive and peripheral function. METHODS: Magnetization transfer ratio [MTR], white matter hyperintensities [WMH], brain atrophy [BA] and brain infarcts [BI] were measured in 795 participants of the AGES-Reykjavik Study cohort (mean 75.6 years, 58.9% women). RESULTS: In women, lower MTR, higher WMH and BA, but not BI, remained associated with slower gait independent of each other and of other covariates. In men, WMH and BA, but not MTR or BI, remained associated with slower gait independently of each other. Only muscle strength, executive control function and depression test scores substantially attenuated these associations. INTERPRETATIONS: MTR in older adults may be an important additional marker of brain abnormalities associated with slower gait. Studies to explore the relationship between brain micro- and macrostructural abnormalities with gait and the role of mediating factors are warranted.
    • Maintenance therapy of childhood acute lymphoblastic leukemia revisited-Should drug doses be adjusted by white blood cell, neutrophil, or lymphocyte counts?

      Schmiegelow, Kjeld; Nersting, Jacob; Nielsen, Stine Nygaard; Heyman, Mats; Wesenberg, Finn; Kristinsson, Jon; Vettenranta, Kim; Schrøeder, Henrik; Weinshilboum, Richard; Jensen, Katrine Lykke; et al. (Wiley-Blackwell, 2016-12)
      6-Mercaptopurine (6MP) and methotrexate (MTX) based maintenance therapy is a critical phase of childhood acute lymphoblastic leukemia treatment. Wide interindividual variations in drug disposition warrant frequent doses adjustments, but there is a lack of international consensus on dose adjustment guidelines.
    • Major cardiac rupture following surgical treatment for deep sternal wound infection.

      Thorsteinsson, David T; Valsson, Felix; Geirsson, Arnar; Gudbjartsson, Tomas; Landspitali Univ Hosp, Dept Cardiothorac Surg, Reykjavik, Iceland Landspitali Univ Hosp, Dept Anesthesia & Intens Care, Reykjavik, Iceland Yale Univ, Sect Cardiac Surg, New Haven, CT USA Univ Iceland, Fac Med, Reykjavik, Iceland (Oxford University Press, 2013-05)
      We report a case of an 80-year old male patient who sustained a major rupture of the right ventricle after surgical revision of an infected sternotomy wound following coronary artery bypass surgery. The rupture of the right ventricle occurred despite an early wound debridement and the use of negative pressure wound therapy on the sternum that did not provide sufficient stability to the sternum after the sternal wires were removed. The rupture resulted in a major bleeding but by establishing emergent cardiopulmonary bypass, the patient was saved.
    • Major ischaemic stroke caused by an air embolism from a ruptured giant pulmonary bulla.

      Gudmundsdottir, Johanna F; Geirsson, Arnar; Hannesson, Petur; Gudbjartsson, Tomas; 1Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland. 2Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland. 3Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland. (BMJ, 2015)
      We report an extremely rare complication of a major ischaemic cerebral event caused by an air embolism due to spontaneous rupture of a giant pulmonary bulla that occurred during an airline flight. Shortly after take-off, the patient experienced sudden right-sided hemiplegia and dyspnoea. Following an emergency landing in Reykjavik, a CT scan of the brain showed minute air bubbles consistent with air emboli within the left-sided intracerebral arteries, and MRI showed signs of acute ischaemic cerebral infarction in the left hemisphere. The patient later underwent a pulmonary lobectomy and survived this life-threatening complication with relatively mild neurological sequelae.
    • Major neonatal surgery under local anesthesia: a cohort study from Bangladesh.

      Hagander, L; Kabir, M; Chowdhury, Md Z; Gunnarsdóttir, A; Habib, Md G; Banu, T; [ 1 ] Childrens Hosp, Dept Pediat Surg, Lund, Sweden [ 2 ] Lund Univ, Dept Clin Sci, Fac Med, Lund, Sweden [ 3 ] Harvard Univ, Sch Med, Program Global Surg & Social Change, Dept Global Hlth & Social Med, Boston, MA USA [ 4 ] Chittagong Med Coll & Hosp, Dept Pediat Surg, Chittagong 4000, Bangladesh [ 5 ] Karolinska Univ Hosp, Dept Pediat Surg, Astrid Lindgren Children Hosp, Stockholm, Sweden [ 6 ] Landspitali Univ Hosp, Dept Pediat Surg, Children Hosp Hringurinn, Reykjavik, Iceland (Springer, 2015-04)
      Surgeons and anesthetists must respond to the perioperative mortality associated with general anesthesia in developing countries. The safety of performing major neonatal surgery under local anesthesia is one pragmatic response. This study describes and evaluates such practice in a tertiary pediatric surgery center in Bangladesh.
    • A major susceptibility gene for asthma maps to chromosome 14q24

      Hakonarson, Hakon; Bjornsdottir, Unnur S; Halapi, Eva; Palsson, Snaebjorn; Adalsteinsdottir, Elva; Gislason, David; Finnbogason, Gudmundur; Gislason, Thorarinn; Kristjansson, Kristleifur; Arnason, Thor; et al. (University of Chicago Press, 2002-09-01)
      Asthma is a complex genetic disorder with a heterogeneous phenotype, largely attributed to the interactions among many genes and between these genes and the environment. Numerous loci and candidate genes have been reported to show linkage and association to asthma and atopy. Although some studies reporting these observations are compelling, no gene has been mapped that confers a sufficiently high risk of asthma to meet the stringent criteria for genomewide significance. Using 175 extended Icelandic families that included 596 patients with asthma, we performed a genomewide scan with 976 microsatellite markers. The families were identified by cross-matching a list of patients with asthma from the Department of Allergy/Pulmonary Medicine of the National University Hospital of Iceland with a genealogy database of the entire Icelandic nation. We detected linkage of asthma to chromosome 14q24, with an allele-sharing LOD score of 2.66. After we increased the marker density within the locus to an average of one microsatellite every 0.2 cM, the LOD score rose to 4.00. We designate this locus "asthma locus one" (AS1). Taken together, these results provide evidence of a novel susceptibility gene for asthma on chromosome 14q24.
    • The majority of early term elective cesarean sections can be postponed.

      Hardardottir, Hildur; Thorkelsson, Thordur; Rikhardsdottir, Johanna Vigdis; 1 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 2 Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland. 3 Department of Neonatology, Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland. (Taylor & Francis, 2019-11-21)
      Introduction: To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370-386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity.Material and methods: Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent.Results: There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370-386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370-386 weeks gestation compared to 2.4% at 390-421 weeks gestation (p < .001).Conclusion: Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.
    • The majority of patients with psoriatic arthritis are not eligible for randomised clinical trials.

      Runarsdottir, Eydis E; Gunnarsdottir, Anna I; Love, Thorvardur J; Gunnarsson, Petur S; Gudbjornsson, Bjorn; 1 Faculty of Pharmaceutical Sciences, The University of Iceland, Reykjavik, Iceland. 2 Faculty of Pharmaceutical Sciences, The University of Iceland and Hospital Pharmacy, The University Hospital of Iceland, Reykjavik, Iceland. annaig@landspitali.is. 3 Faculty of Medicine, The University of Iceland and Department of Education, Research and Development, The University Hospital of Iceland, Reykjavik, Iceland. 4 Faculty of Pharmaceutical Sciences, The University of Iceland and Hospital Pharmacy, The University Hospital, Reykjavik, Iceland. 5 Faculty of Medicine, The University of Iceland and Centre for Rheumatology Research, The University Hospital of Iceland, Reykjavik, Iceland. (Clinical And Experimental Rheumatology S.A.S, 2018-11)
      To identify the proportion of patients with psoriatic arthritis (PsA) who would meet inclusion criteria of the randomised clinical trials that were performed leading up to registration of the tumour necrosis factor inhibitors (TNFi). Data from 329 patients with PsA were obtained from an Icelandic database, ICEBIO, medical records at the University Hospital of Iceland, and the private out-patient clinic Laeknasetrid Ltd. The patients were classified according to whether they met the inclusion criteria of the clinical trials that were performed ahead of the registration of each respective TNFi. The reasons for exclusion were also explored. 34% of the patients with complete data available met the inclusion criteria. Clinical data in respect to exclusion and inclusion criteria were incomplete for 13% of the cases. The proportion of patients who met the inclusion criteria was highest among those who received adalimumab and etanercept (53%). Patients who received in iximab had the lowest inclusion rate (23%). The main reason why patients did not meet the inclusion criteria was too few swollen and/or tender joints, or in 45% of excluded cases. Our results demonstrate that two thirds of patients with PsA in Iceland who are treated with TNFi would not have qualified for the randomised clinical trials performed leading up to the registration of the medications. Further studies with regards to whether outcomes are different between those who met the inclusion criteria and those who did not remain to be performed.
    • Making sense of the situation: women's reflection of positive fetal screening 11-21 months after giving birth.

      Kristjansdottir, Hildur; Gottfredsdottir, Helga; Univ Iceland, Fac Nursing, Dept Midwifery, IS-101 Reykjavik, Iceland, Directorate Hlth, Reykjavik, Iceland (Elsevier Science Ltd., 2014-06)
      we aimed to gain insights into women's reflection on their experience of receiving a false-positive screening result for fetal anomalies, more than 11 months from birth.
    • Male breast cancer in BRCA1 and BRCA2 mutation carriers: pathology data from the Consortium of Investigators of Modifiers of BRCA1/2.

      Silvestri, Valentina; Barrowdale, Daniel; Mulligan, Anna Marie; Neuhausen, Susan L; Fox, Stephen; Karlan, Beth Y; Mitchell, Gillian; James, Paul; Thull, Darcy L; Zorn, Kristin K; et al. (BioMed Central Ltd2016, 2016)
      BRCA1 and, more commonly, BRCA2 mutations are associated with increased risk of male breast cancer (MBC). However, only a paucity of data exists on the pathology of breast cancers (BCs) in men with BRCA1/2 mutations. Using the largest available dataset, we determined whether MBCs arising in BRCA1/2 mutation carriers display specific pathologic features and whether these features differ from those of BRCA1/2 female BCs (FBCs).
    • Male breast cancer in Iceland

      Jonasson, J G; Agnarsson, B A; Thorlacius, S; Eyfjord, J E; Tulinius, H; Department of Pathology, University Hospital, Reykjavik, Iceland. (John Wiley & Sons Inc, 1996-02-08)
      All malignant tumours of the male breast diagnosed in Iceland during the 40-year period 1955-1994 were studied with regard to histological classification, tumour grading and flow cytometric analysis. Of 31 malignant tumours diagnosed, 29 were primary breast carcinomas. Male breast carcinoma constitutes 1% of all breast malignancies in Iceland and 0.25% of all malignant tumours in males. About 80% of the male breast carcinomas were diagnosed during the latter half of the study period. The mean age of the patients was 66.3 years and the left-to-right ratio was 1.9:1.0. Right-sided tumours appeared to be more aggressive. The mean tumour size was 2.6 cm. The vast majority of the carcinomas (79%) were of the infiltrating ductal type. Of these 21.7% were grade I, 43.5% were grade II and 34.8% grade III. Papillary carcinomas made up 17% of the total. These occurred in slightly older patients than the infiltrating ductal carcinomas and were diploid tumours. In this study 57% of the tumours were found to be aneuploid, but nearly 70% of the invasive ductal carcinomas NOS were aneuploid. In general, the aneuploid tumours were larger, of higher average histological grade and had a higher mean S-phase value. The overall mean S-phase fraction was 7.2% which is similar to that found in female breast tumours in Iceland. It is concluded that male-to-female ratio of breast carcinoma in Iceland is similar to that found in other Western countries. The age-standardised incidence has increased considerably in the last 20 years, in contrast to the rates reported from most other countries. Papillary tumours are unusually common in Icelandic males.
    • Male-female differences in the association between incident hip fracture and proximal femoral strength: a finite element analysis study.

      Keyak, J H; Sigurdsson, S; Karlsdottir, G; Oskarsdottir, D; Sigmarsdottir, A; Zhao, S; Kornak, J; Harris, T B; Sigurdsson, G; Jonsson, B Y; et al. (2011-06-01)
      Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F(Stance)) and posterolateral fall (F(Fall)) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F(Stance) and F(Fall) in incident hip fracture subjects were 13%-25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that F(Stance) and F(Fall) in fracture subjects were greater in men than in women (p < 0.001). For men, F(Stance) was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F(Stance) provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis.
    • Malignant mesothelioma incidence by nation-wide cancer registry: a population-based study.

      Tomasson, Kristinn; Gudmundsson, Gunnar; Briem, Haraldur; Rafnsson, Vilhjalmur; 1Department of Occupational Medicine, Administration of Occupational Safety and Health, Reykjavik, Iceland. 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland ; Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Fossvogur, 108 Reykjavik, Iceland. 3Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland. 4Department of Preventive Medicine, University of Iceland, Stapi/ Hringbraut, Reykjavik, Iceland. (BioMed Central, 2016)
      Malignant mesothelioma caused by asbestos exposure has a long latency period. A ban on asbestos use may not be apparent in decreased incidence in the population until after several decades. The aim was to evaluate changes in the incidence of malignant mesothelioma, and the possible impact of the asbestos ban implemented in Iceland in 1983.
    • Malignant nasopharyngeal tumours in Iceland

      Johannsson, J; Sveinsson, T; Agnarsson, B A; Skaftason, S; Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark. (Taylor & Francis, 1997)
      From 1965 to 1990, 46 cases of malignant nasopharyngeal tumours were diagnosed in Iceland. The incidence rate is as low as in other Western countries, 0.6/100,000 per year. Histo-pathological diagnosis were as follows: Undifferentiated carcinoma 45%; squamous cell carcinoma 30%; non-keratinizing carcinoma 7%; and plasmacytoma 9%; lymphoma 7%; rhabdomyosarcoma 2%. Four per cent were diagnosed at stage I, 13% at stage II, 29% at stage III and 54% at stage IV. The overall crude survival at 10 years from diagnosis was 28.3%. The following factors were found to have a prognostic value: Stage of disease, size of tumour (T-classification) and age at diagnosis. Nodal stage (N-classification) alone and sex were not found to be prognostic factors. There was no difference in survival among the different WHO types of cancer. Patients with carcinoma were all treated with radiotherapy. The survival of those who received more than 60 Gy was better than of those who received 60 Gy or less (p = 0.04).
    • The Malignant Role of Exosomes as Nanocarriers of Rare RNA Species.

      Zimta, Alina-Andreea; Sigurjonsson, Olafur Eysteinn; Gulei, Diana; Tomuleasa, Ciprian; 1Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania. 2The Blood Bank, Landspitali University Hospital, 121 Reykjavik, Iceland. 3School of Science and Engineering, Reykjavik University, 107 Reykjavik, Iceland. 4Department of Hematology, Oncology Institute Prof. Dr. Ion Chiricuta, 400015 Cluj-Napoca, Romania. (MDPI, 2020-08-15)
      Nowadays, advancements in the oncology sector regarding diagnosis methods allow us to specifically detect an increased number of cancer patients, some of them in incipient stages. However, one of the main issues consists of the invasive character of most of the diagnosis protocols or complex medical procedures associated with it, that impedes part of the patients to undergo routine checkups. Therefore, in order to increase the number of cancer cases diagnosed in incipient stages, other minimally invasive alternatives must be considered. The current review paper presents the value of rare RNA species isolated from circulatory exosomes as biomarkers of diagnosis, prognosis or even therapeutic intervention. Rare RNAs are most of the time overlooked in current research in favor of the more abundant RNA species like microRNAs. However, their high degree of stability, low variability and, for most of them, conservation across species could shift the interest toward these types of RNAs. Moreover, due to their low abundance, the variation interval in terms of the number of sequences with differential expression between samples from healthy individuals and cancer patients is significantly diminished and probably easier to interpret in a clinical context.
    • Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection.

      Zindovic, Igor; Gudbjartsson, Tomas; Ahlsson, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C; Hjortdal, Vibeke; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; et al. (Mosby-Elsevier, 2019-04)
      To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry. We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality. Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009). Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.
    • The management and survival outcomes of nasopharyngeal cancer in the Nordic countries

      Mäkitie, A.; Ruuskanen, M.; Bentzen, J.; Brun, E.; Gebre-Medhin, M.; Friesland, S.; Marsk, E.; Hammarstedt-Nordenvall, L.; Gille, E.; Reizenstein, J.; et al. (Taylor & Francis, 2017-12-05)