Using Scandinavian literature reporting patient experiences of intensive care as a case, the aim of this qualitative systematic review was to explore if humanising was addressed in the descriptions of patient experiences and, if so, what words and theoretical perspectives were used to underpin the results. A comprehensive search of qualitative studies published between 1 January 2016 and 12 December 2024 was conducted in Embase, CINAHL, MEDLINE, Scopus, and Web of Science. Twenty-nine studies reporting patient ICU experiences were included and analysed using thematic synthesis following Thomas and Harden. The review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. The terms humanisation and de-humanisation were not explicitly used, but the studies engaged with these concepts by corroborating the three themes that defined humanising ICU in this study: (1) feeling recognised as a human being when experiencing connectedness with healthcare professionals, (2) feeling connected with themselves and the situation when experiencing safety and well-being, and (3) feeling connected with significant persons and life outside the ICU. In addition, our analysis identified a further theme: (4) experiencing capacity to influence the situation when able to express themselves. Humanising intensive care involves ethical and caring engagement with the patient, helping them feel connected, experience well-being, and influence their situation. Although Scandinavian literature has not directly studied humanisation, it has focused on understanding patients' experiences and addressing the ontology of critical illness. As such, humanising ICU aligns well with Scandinavian nursing traditions.Implications for clinical practiceICU staff should actively listen to patients and encourage them to express needs and preferences, create a safe and calm environment that supports well-being, and maintain communication with patients and families to promote a humanising approach to intensive care.
The use of antipsychotic drugs has increased in recent years, extending beyond traditional indications like schizophrenia and bipolar disorder while the use of lithium has remained stable or declined. However, current data on prescribing trends and dosages in Scandinavian countries are limited. This study aims to analyze trends in the prevalence and dosing of antipsychotics and lithium in Scandinavia from 2010 to 2023. Data were obtained from national prescription registers in Norway, Sweden, and Denmark, covering 2010–2023. For each antipsychotic class, we calculated: one-year prevalence (users per 1,000 inhabitants), therapeutic intensity (Defined Daily Doses [DDD] per 1,000 inhabitants per day), and mean dose (DDD per user per day). These metrics were analyzed overall, by sex, and by age groups. In 2010–2023, overall antipsychotic use increased across all countries, with Sweden (+ 24.4%) and Norway (+ 23.7%) experiencing the largest rises, and Denmark (+ 8.1%) the smallest. Lithium use was stable in Denmark, decreased in Norway, and increased in Sweden. Use was most prevalent among women and adults aged 25–44, primarily driven by a rise in second-generation antipsychotics (SGAs), especially quetiapine. Over the period, quetiapine’s therapeutic intensity increased (e.g., Norway from 1.29 to 2.96 DDD/1,000 inhabitants/day; Sweden from 0.91 to 1.58; Denmark from 2.32 to 3.07), while its mean dose decreased (e.g., Norway from 0.63 to 0.18 DDD/user/day; Sweden from 0.35 to 0.22; Denmark from 0.34 to 0.20), indicating a trend toward low dose prescribing. From 2010 to 2023, prescribing patterns of antipsychotics in Scandinavia shifted toward increased use of SGAs, higher therapeutic intensity, and lower mean doses for most drugs within this class. These trends were especially notable for quetiapine and could be influenced by off-label use. These findings highlight the importance of ongoing monitoring and research that integrates prescription data with clinical information to enhance safety and promote evidence-based prescribing. The online version contains supplementary material available at 10.1186/s12888-026-08006-z.
Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals' perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs. A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services. In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care. Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities. This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.
Recent decades have seen pronounced changes in European hydroclimate, including widespread summer drying, yet its spatiotemporal variability and underlying drivers remain uncertain. Here we present the European Last Millennial Data Assimilation (EULMDA), a new reconstruction of European hydroclimate and its main drivers covering the past millennium. EULMDA integrates five Earth System Model simulations with over one hundred moisture and temperature sensitive tree-ring records. It demonstrates high skill in reproducing instrumental variability across climate variables, including large-scale atmospheric circulation changes. We show that European warm-season drought variability is primarily governed by circulation changes associated with the Scandinavian pattern (SCAND) and long-term summer temperature changes, together explaining over half of the spatiotemporal drought variance. SCAND drives a pronounced north-south dipole in summer hydroclimate, explaining a larger fraction of Mediterranean drought variability than other major circulation modes, contributing to recent multidecadal drying in the Mediterranean alongside wetting in northern Europe. Meanwhile, summer warming intensifies drying across much of Europe. These results provide critical context for interpreting recent drought trends and insight into mechanisms shaping future hydroclimate risks.
It remains a challenge to obtain well-preserved tissue samples from deceased patients as access to regular autopsy is limited. Minimally invasive autopsy (MIA) is a potential alternative to the complete diagnostic autopsy because of its efficacy in providing non-autolyzed tissue samples and its increased acceptability amongst the bereaved. The study follows an exploratory, prospective design without any kind of intervention. Inclusion criteria are deceased adults (≥ 18 years), confirmed signs of death, uncertain or multifactorial cause of death, present or previous infection, and permission from next of kin to perform MIA, defined by ultrasound (US)-guided samples from the heart, lungs, liver, spleen, and kidneys using a TruCut semi-automatic coaxial needle (14G; 16 cm length). Tissue samples, fixed in BiopSafe 20 mL formalin test tubes, are sent for pathological evaluation. The primary outcome is the achievement of well-preserved tissue samples, representative of the target organ and suitable for histopathological evaluation and diagnosis. An exploratory outcome is to establish the degree of clinico-pathological discrepancies between pre-mortem clinical status and post-mortem pathological descriptions. This investigator-initiated study is designed to validate the feasibility of MIA to enable fast-track post-mortem evaluation in an ICU environment.
To investigate the association between use of GLP-1 receptor agonists and incident Parkinson's disease. Cohort study using data from nationwide registers in Denmark, Norway and Sweden and an active-comparator, new-user design. We included 158 961 new users of GLP-1 receptor agonists and 188 065 new users of sulfonylureas, aged 45 years or older. Liraglutide accounted for 72.9% of GLP-1 receptor agonist follow-up time, followed by semaglutide (13.4%), exenatide (7.3%), dulaglutide (5.1%) and lixisenatide (1.3%). The primary outcome was incident Parkinson's disease, defined as a first-ever diagnosis of Parkinson's disease (ICD-10 G20) or Parkinson's disease dementia (ICD-10 F02.3) in national patient registers. Cox regression with propensity score weighting was used to estimate hazard ratios (HRs) and control for confounding. Mean age was 65 years and 43% were female. Incidence rates for Parkinson's disease were 5.2 and 8.0 per 10 000 person-years among GLP-1 receptor agonist and sulfonylurea users, respectively (adjusted HR 0.81 [95% CI 0.68-0.96]). Results were consistent in a 2-year lag-time analysis (HR 0.84 [95% CI 0.70-1.02]) after excluding or censoring users of DPP-4 inhibitors at cohort entry or during follow-up (HR 0.74 [95% CI 0.60-0.93]) and in subgroup analyses by sex and age. In this large observational cohort study, use of GLP-1 receptor agonists compared with sulfonylureas was associated with a lower risk of incident Parkinson's disease. These findings support a potential neuroprotective role of GLP-1 receptor agonists, though replication in additional studies is needed.
Skin wounds remain a clinical challenge, especially for burns and chronic wounds, and existing therapies seldom re-engage the rapid, scar-sparing repair programs observed in nature. Planarians are super-regenerators capable of rebuilding the entire organism from small fragments, and their extracellular vesicles might encode potent prorepair cues. But whether planarian-derived extracellular vesicles (EVs) can enhance mammalian skin healing is unknown. Therefore, we isolated EVs from a wild-type planarian flatworm collected in Sweden and evaluated their therapeutic activity in complementary wound models: a chicken chorioallantoic membrane assay and a human 3D skin model. In our models, planarian EVs significantly accelerated tissue regeneration and wound closure, and improved re-epithelialization and barrier integrity compared to controls. These data indicate that cross-species (xenogeneic) EVs from planarians carry bioactive factors capable of expediting cutaneous repair. Together, the results position planarian-derived EVs as a potential cell-free therapeutic strategy for burns and chronic wounds, motivating additional mechanistic and translational studies for clinical use.
Bereavement support for families experiencing the loss of a child is a crucial aspect of Specialized Paediatric Palliative Care (SPPC). As an offering of SPPC, bereavement groups have the potential to provide meaningful support. Limited research, however, exists considering parents' direct experiences of these groups and considerations for how to approach them in a Scandinavian context. To explore parents' experiences of bereavement support groups to explicate thematic priorities that speak to the design, facilitation, and other practical considerations for delivering these groups in a Scandinavian context. A qualitative study, inspired by a phenomenological approach, was conducted in a regional Danish hospital-based bereavement program. Parents who had lost a child and participated in a bereavement group were invited to share their experiences in a focus group and/or individual interview. Thematic analysis methods were utilized to explicate thematic priorities. Three thematic priorities were articulated for delivering bereavement support groups: (1) to cultivate a sense of belonging; (2) To share and bear memories that sustain presence; and, (3) to support parents make sense of past experiences in the present. Additional specific practical considerations were elucidated. In a Scandinavian context, hospital-initiated bereavement groups may aspire to provide a shared space for parents to engage with existential aspects of loss. This study contributes to evolving understandings of best practices for bereavement support in regional paediatric palliative care programs.
Primary sclerosing cholangitis (PSC) has a variable disease course, complicating patient counseling and timing of liver transplantation. Vitamin B6 deficiency predicts reduced liver transplantation-free survival in Scandinavian PSC cohorts. Here, we aimed to validate this observation in U.S. and German PSC cohorts and expanded our analyses to include hepatic decompensation as a clinical outcome. Serum active vitamin B6 (pyridoxal 5'-phosphate, PLP) was analyzed using LC-MS/MS in retrospective cohorts of people with PSC from Norway (NOR, N=315), the U.S. (USA, N=756), and Germany (GER, N=149). Cox proportional hazards and Fine and Gray competing risk models were fitted to estimate the ability of PLP to predict liver transplantation-free survival and the cumulative incidence of hepatic decompensation, respectively. The prevalences of vitamin B6 deficiency (PLP<20 nmol/L) in pre-transplant PSC from the NOR and USA cohorts were 50% and 25%. The prevalence was higher among those with previous hepatic decompensation. The cumulative incidence of hepatic decompensation was higher in the USA cohort, while individuals in the NOR cohort were more commonly transplanted for indications other than hepatic decompensation. Despite differences in clinical practice, low PLP consistently associated with shorter liver transplant-free survival, and PLP added value to predict liver transplantation or death from PSC over and above contemporary prediction models. Low PLP also associated with higher incidence of hepatic decompensation, which was mainly evident in the USA cohort, where decompensation was more common. The risk of both outcomes rose sharply in the definitive and marginal deficiency ranges and plateaued beyond sufficiency levels. Vitamin B6 deficiency was common in PSC also outside Scandinavia and consistently associated with poor outcomes in geographically distinct PSC populations. We previously showed that vitamin B6 deficiency was prevalent and associated with reduced liver transplantation-free survival in Scandinavian PSC cohorts. The current work shows that these observations are translatable to a U.S population and that low vitamin B6 also associates with development of hepatic decompensation. Our findings show that vitamin B6 adds value to predict outcomes in PSC across geographically distinct PSC populations and that efforts to restore B6 sufficiency should be focused on the many individuals who present with vitamin B6 levels within the marginal-to-definitive deficiency range.
The European green toad (Bufotes viridis) is Sweden's most threatened amphibian. Its range has contracted over the past century, with many local extinctions; remaining populations are fragmented and often isolated. Since the 1990s, conservation has focused on translocations to existing breeding sites and new localities, but many efforts have had limited success. We detected lower genetic diversity in Scandinavian populations (southern Sweden and nearby Denmark) than in Poland, plus strong structure and differentiation among Scandinavian subpopulations, implying unexpectedly low gene flow despite translocations. Small, isolated populations are strongly affected by drift, and whole-genome analyses reveal inbreeding and high genetic load in some subpopulations. We recommend reassessing source populations for translocations: the stock used in captive breeding and most past releases shows intermediate diversity but also signs of divergent selection and putative local adaptation. Management should balance minimizing inbreeding depression against risks of outbreeding depression and erosion of local adaptation risks.
The ICD-11 classification of Personality Disorder (PD) relies on global severity of personality dysfunction, while up to five trait domains can be specified as individual expressions (i.e. Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). The 60-item Personality inventory for ICD-11 (PiCD) was developed to measure these domains but has not yet been evaluated in Scandinavian context. Using a representative and socio-demographically stratified sample of the Danish adult population (N = 714), this study aimed to investigate the psychometric properties of the PiCD and to provide normative data for clinical cutoffs and interpretation of scores. Results support a four-factor model, including a bipolar dimension of Disinhibition versus Anankastia, which is consistent with previous studies. The hierarchical structure from one global factor to the four specific factors also revealed a conceptually coherent pattern across all four levels. The PiCD domain scores show acceptable internal consistency and significant associations with psychosocial functioning (particularly for Negative affectivity and Detachment scores). The findings overall support the PiCD's utility in assessing ICD-11 trait domains and highlight the importance of representative normative data for clinical application in Scandinavian contexts. Normative data, tentative-cutoffs, and a scoring-key for a clinical interpretive report are provided to guide clinical interpretation and decision-making.
To assess incidence, indications, symptom relief, complications, and weight outcomes following Roux-en-Y gastric bypass (RYGB) reversal. RYGB is an effective treatment for obesity but may in rare cases be associated with severe long-term complications requiring RYGB reversal. Evidence on incidence and outcomes is limited. This nationwide, multi-center, retrospective cohort study included all patients undergoing RYGB reversal in Sweden between 2007 and 2023. Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) and medical records. During the study period, 199 patients (84% female, mean age 42.5 y) underwent RYGB reversal at 13 centers, corresponding to an incidence of 0.3% of 63,797 RYGB-procedures performed. Patients usually had multiple indications, most often abdominal pain (70%), malnutrition (45%), gastrointestinal symptoms (34%), and postbariatric hypoglycemia (29%). Most procedures (84%) were performed laparoscopically, with a median hospital stay of 4 days. Mean body weight increased from 77 kg at reversal to 89 kg at one year. Overall, 86% of patients reported partial or complete symptom relief, highest rates among those with postbariatric hypoglycemia (94.6%). Early severe complications (Clavien-Dindo grade ≥IIIb) occurred in 24.6% and late severe complications in 21.6%, with seven not surgery-related deaths (3.5%) during follow-up. Reversal of RYGB is rare but can be considered in patients with a substantial burden of complications. Although postoperative morbidity was common, most patients achieved symptom relief. Careful patient selection, perioperative optimization, and realistic expectations are essential. Further studies are needed to determine optimal surgical techniques and long-term outcomes.
Social disparities in healthcare access and utilisation are well-documented. However, the underlying mechanisms driving these disparities are not fully uncovered. This study presents a systematic review of qualitative research exploring organisational and relational factors that contribute to social disparities in healthcare encounters. The review was conducted in three scientific databases (PubMed, Embase and PsycInfo). Studies were independently screened by two researchers, and the quality was assessed using the Critical Appraisal Skills Programme assessment tool. A thematic analysis was used to identify patterns across included studies. In total, 15 qualitative studies were included, from which 10 themes were identified, including: (1) complexity of the healthcare system, (2) resource constraints in the healthcare system, (3) deficiencies in healthcare professionals' education, (4) patients' perceptions of health and illness, (5) roles and expectations in patient decision-making and communication, (6) prejudices and labelling of patients with lower socioeconomic status, (7) equality and power balance in healthcare interactions, (8) patients' financial and social living circumstances, (9) patients' understanding of health information, and (10) trust and respect in healthcare interactionsConclusions:The study identified key mechanisms that contribute to social disparities in healthcare encounters between patients and the healthcare system. These findings may inform future health interventions and policy actions aimed at reducing social disparities in patient-healthcare interactions. However, further research within the Scandinavian context is warranted to validate and expand upon these results.
Studies show equal or better resolution of type 2 diabetes mellitus (T2D) and other metabolic outcomes after Roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy (SG), but it is unclear whether this is related only to the higher weight loss after RYGB, or if there are weight-loss-independent factors. The objective of this study was to examine weight-loss-independent differences in metabolic outcomes between RYGB and SG. This study utilized the Scandinavian Obesity Surgery Registry and the Swedish National Diabetes Register. All included patients had presurgical T2D and matching was between RYGB or SG using a 1:1 propensity score, matching with a generalized linear model including age, sex, BMI at baseline, comorbidities (cardiovascular, dyslipidemia, sleep apnea, and hypertension), T2D parameters at baseline (HbA1c, number of T2D medications, insulin use, duration of T2D), year of surgery and percentage Total Weight Loss (%TWL) at nadir. The ensuing cohort was compared regarding remission and improvements in T2D, and other cardiometabolic outcomes, including major adverse cardiovascular events (MACE). 1440 individuals (720 RYGB; 720 SG) were matched 1:1 using Propensity score. There were 494 (68.6%) patients in complete T2D remission at 2 years after RYGB, and 438 (60.8%) after SG, (OR: 0.75, 95% CI 0.60 - 0.93, p = 0.010) despite similar TWL (Standardized mean difference 0.12). SG also had a lower rate of pharmacological remission for T2D (OR 0.71, 95% CI 0.56-0.88, p = 0.002), and hypertension remission (OR 0.70, 95% CI 0.52-0.94, p = 0.019), but there was no significant difference in pharmacological remission regarding dyslipidemia (OR 0.83, 95%CI 0.66-01.04, p = 0.11). No difference was seen in the risk for MACE (SG vs. RYGB HR:1.45, 95%CI 0.89-2.38, p = 0.136). RYGB is associated with a greater rate of T2D remission compared to SG. This study suggests that these improved outcomes are independent of the degree of weight loss.
Smokeless tobacco (SLT) use during pregnancy remains a significant yet underrecognized public health concern, particularly in low- and middle-income countries. Despite its wide prevalence and potential for adverse maternal and foetal outcomes, SLT has received comparatively less attention than smoking in prenatal health initiatives. This systematic review and meta-analysis aimed to estimate the global and regional prevalence of SLT use among pregnant women and examine associated sociodemographic patterns. We systematically searched PubMed, Embase, Scopus, and regional databases for studies reporting the prevalence of SLT use during pregnancy up to 31 January 2025. Cross-sectional, cohort, and survey-based studies were eligible for inclusion. Two reviewers independently screened articles, extracted data, and assessed study quality. Pooled prevalence estimates were calculated using a random-effects meta-analysis model due to anticipated heterogeneity. Subgroup analyses were conducted based on geography, rural versus urban setting, and education level. Thirty-four studies encompassing data from over 9 509 590 pregnant women across Asia, Africa, Europe, North America, and Oceania were included. The pooled prevalence of SLT use during pregnancy was 8% (95% CI: 7%-10%), with a significant heterogeneity (I2 = 100%, P < .001), indicating substantial variation across studies. There was a wide regional variation, from <1% in Scandinavian countries to >60% in rural Indonesia and Palau. Higher prevalence was consistently observed among women from lower socioeconomic backgrounds, with limited education, and residing in rural settings. Cultural normalization and habitual use were common reasons for SLT use in these populations. SLT use during pregnancy is prevalent in several parts of the world, especially among socioeconomically disadvantaged populations. These findings underscore the urgent need for targeted tobacco control interventions, maternal health education, and region-specific policy strategies addressing SLT use during pregnancy. Increased awareness, regulatory action, and integration of SLT screening in antenatal care services are warranted.
Low vitamin D levels in individuals with idiopathic scoliosis (IS) have been reported and suggested as a potential contributor to IS. Bone density has also been shown to be lower in individuals with IS. To investigate serum levels of vitamin D, parathyroid hormone (PTH), markers of bone metabolism, and the genetic variation associated with vitamin D levels and bone density in individuals with IS and healthy controls. Case-control study combining Scandinavian serum cohorts and genetic cohorts. Serum analyses: 174 individuals with IS and 153 non-scoliotic controls. 1,394 individuals with IS and 11,108 controls. Serum 25-hydroxyvitamin D [25(OH)D)], PTH, C-terminal telopeptide (CTX), osteocalcin, calcium, phosphate, creatinine, albumin, ALP and leptin. Polygenic risk scores (PRS) for 25(OH)D and bone mineral density (BMD). Serum samples were analyzed using validated clinical laboratory methods. PRS for 25(OH)D and bone mineral density (BMD) were calculated based on previous literature. Statistical analyses were performed using Mann-Whitney U-tests, logistic and linear regression. Mendelian randomization was analyzed using logistic regression and the inverse-variance weighted method. In the serum cohort, median 25(OH)D levels were 54.4 nmol/L in individuals with IS and 67.0 nmol/L in controls. Corresponding PTH levels were 4.0 pmol/L and 3.2 pmol/L. No statistically significant differences were found in CTX, osteocalcin, ALP, or leptin. PRS for 25(OH)D was associated with serum 25(OH)D levels. PRS in individuals with IS and controls were non-significant for 25(OH)D, BMD femoral neck, and BMD lumbar spine. A tendency for lower values for estimated BMD heel was seen in individuals with scoliosis compared to controls. Our findings indicate altered regulation of the vitamin D-PTH axis in idiopathic scoliosis, likely driven by environmental rather than genetic factors. Bone turnover markers were comparable between groups, no clear genetically mediated BMD differences could be observed.
Difficulties in emotion regulation lie at the core of many mental health challenges. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF) is a widely used tool for measuring such difficulties. Although it has been translated into several languages and validated across various countries worldwide, its psychometric properties have not been thoroughly examined in Scandinavian populations. This study aimed to replicate the original multidimensional six-factor DERS-SF model in a Norwegian sample, compare it with alternative models, and examine its correlation with psychological distress. As part of a randomized controlled trial (RCT), 138 parents of children with mental health disorders completed the DERS-SF and the 10-item Symptom Check List (SCL-10). Confirmatory factor analyses (CFAs) were conducted to compare the six-factor model with a five-factor model and two hierarchical models. CFAs supported the six-factor, five-factor and hierarchical models. All showing good model fit. The six-factor model was preferred over the five-factor model based on theoretical considerations regarding the inclusion of the Awareness factor. Reliability analysis yielded McDonald's omega values ranging from 0.61 to 0.94. A positive correlation between emotion regulation difficulties and psychological distress was observed (r = 0.445, p < 0.001). The findings supported the applicability of the DERS-SF in a Norwegian population and its utility for clinical and research purposes. However, as the sample consisted of parents of children receiving mental health care, caution is required when interpreting these results due to potential limitations regarding external validity and generalizability. Trial Registration: ClinicalTrials.gov, identifier: NCT04885036.
Metabolic and bariatric surgery (MBS) can be challenging in patients with a very high body mass index (BMI). The objective of the study is to evaluate the outcomes of different weight categories in a publicly funded healthcare system with high adherence to current guidelines for perioperative optimization. Nationwide, registry-based. Based on nationwide data from the Scandinavian Obesity Surgery Registry, patients operated on with Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD/DS) from 2007 until 2024 were included. Patients were stratified according to preoperative BMIs of 35-49 kg/m2, 50-59 kg/m2, 60-69 kg/m2, and ≥70 kg/m2. The study included data for 83,057 patients. A postoperative complication occurred for 5855 (7.2%) with no difference between BMI groups. Operation time was longer for higher BMI groups for all procedures. At 2 years, patients lost the highest percentage of their total weight (%TWL) in all BMI categories after BPD/DS (37.9% ± 10.1% to 45.4% ± 15.3%), followed by RYGB (32.4% ± 8.6% to 36.8% ± 10.9%) and SG (26.6% ± 9.5% to 31.3% ± 8.9%). Mortality rates over a median of 9.8 years remained higher in the higher BMI groups (BMI: 50-59, odds ratio [OR] = 1.29 [1.15-1.46]; BMI: 60-69, OR = 1.66 [1.18-2.33]; BMI ≥70, OR = 2.33 [.96-5.68]). MBS can be performed safely in patients with obesity class 4 or higher. Higher BMI was associated with longer operating times and superior weight loss, especially after BPD/DS. Despite greater weight loss and similar remission of metabolic co-morbid diseases, patients with higher preoperative BMI still have an increased long-term risk of all-cause mortality.
The cold-water siliceous sponge Geodia barretti, largely present in the North Atlantic Ocean, notably around Scandinavian costs, plays important roles in carbon and silicon cycling in the deep-sea. The demosponge provides a reservoir for numerous microorganisms. Bioactive natural products have been isolated from this sponge, in particular the indole alkaloid barettin discovered forty years ago. Barettin and analogues, notably 8,9-dihydrobarettin, 8,9-dihydro-8-hydroxybarrettin, bromobenzisoxalone barettin, and geobarrettins A-B, contribute to the maintenance of the sponge stability and security (anti-fouling) and the regulation of its microbial environment. The four indole alkaloids 6-bromo-8-hydroxyconicamin, 6-bromoconicamin, and geobarrettin C-D are also implicated in the defense of the sponge against physical and biochemical aggressions. Altogether, these ten natural products are essential to the sponge life. The present review presents a survey of the chemistry and biology associated with Geodia barretti. The pharmacological properties of (dihydro)barettin, notably their antioxidant and anti-inflammatory properties, are discussed, as well as the synthetic processes set up to produce these diketopiperazine derivatives. Their molecular targets and mechanism of action are also discussed. The review takes the sponge G. barretti from the depths of knowledge and brings barettin and analogues to the surface, with the hope of guiding future research in this field.
Variants in the KCNQ1 underlie type 1 long QT syndrome. The clinical manifestations are influenced by the specific KCNQ1 pathogenic variant. We aimed to describe the phenotype in patients found to possess the p.Gln530Ter-KCNQ1 pathogenic variant common in Scandinavian patients with long QT syndrome. Clinical characteristics of p.Gln530Ter-KCNQ1 variant-positive patients from 6 university hospital registries in Sweden, Denmark, Norway, and the United States were compared with carriers of other KCNQ1 pathogenic variants (non-p.Gln530Ter-KCNQ1) and gene-negative controls. Cardiac events (CEs) encompassed syncope of unknown origin and ventricular arrhythmias (VAs) (episodes of torsades de pointes, appropriate implantable cardioverter-defibrillator shocks, aborted cardiac arrest, or sudden cardiac death). The p.Gln530Ter-KCNQ1, non-p.Gln530Ter-KCNQ1, and control groups included 139 (65% female; 24% probands; mean age at end of follow-up 51 ± 20 years), 194 (65% female; mean age 44 ± 19), and 717 individuals (55% female; mean age 39 ± 24), respectively. CEs by 60 years of age were reported in 30 of the p.Gln530Ter-KCNQ1 group (22%; of those 5 VA, all nonfatal), 46 of the non-p.Gln530Ter-KCNQ1 group (24%; 4 VA, all nonfatal), and 81 of controls (11%; no VA). In the p.Gln530Ter-KCNQ1 group, CE occurred at a significantly older age than in the non-p.Gln530Ter-KCNQ1 group (44 ± 22 vs 31 ± 22; P = .02). Before 30 years of age, CE risk in the p.Gln530Ter-KCNQ1 group did not differ from that in controls (adjusted hazard ratio 1.11 [95% confidence interval 0.65-1.89]; P = .707) and was significantly lower than in the non-p.Gln530Ter-KCNQ1 group. After 30 years of age, CE risk in the p.Gln530Ter-KCNQ1 group increased significantly (adjusted hazard ratio 3.21 [95% confidence interval 1.49-6.92]; P = .003, compared with controls) and did not differ from the non-p.Gln530Ter-KCNQ1 group. The p.Gln530Ter-KCNQ1 variant is associated with a later onset of CE than other KCNQ1 pathogenic variants.