| 1. |
|
|
| 2. |
- Back, Erik, et al.
(författare)
-
Mucosal blood flow in the remaining rectal stump is more affected by total than partial mesorectal excision in patients undergoing anterior resection : a key to understanding differing rates of anastomotic leakage?
- 2021
-
Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 406:6, s. 1971-1977
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Anterior resection is the procedure of choice for tumours in the mid and upper rectum. Depending on tumour height, a total mesorectal excision (TME) or partial mesorectal excision (PME) can be performed. Low anastomoses in particular have a high risk of developing anastomotic leakage, which might be explained by blood perfusion compromise. A pilot study indicated a worse blood flow in TME patients in an open setting. The aim of this study was to further evaluate perianastomotic blood perfusion changes in relation to TME and PME in a predominantly laparoscopic context.METHOD: In this prospective cohort study, laser Doppler flowmetry was used to evaluate the perianastomotic colonic and rectal perfusion before and after surgery. The two surgical techniques were compared in terms of mean differences of perfusion units using a repeated measures ANOVA design, which also enabled interaction analyses between type of mesorectal excision and location of measurement. Anastomotic leakage until 90 days after surgery was reported for descriptive purposes.RESULTS: Some 28 patients were available for analysis: 17 TME and 11 PME patients. TME patients had a reduced blood perfusion postoperatively compared to PME patients in the aboral posterior area (mean difference: -57 vs 18 perfusion units; p = 0.010). An interaction between mesorectal excision type and anterior/posterior location was detected at the aboral level (p = 0.007). Two patients developed a minor leakage, diagnosed after discharge.CONCLUSION: Patients operated on using TME have a decreased blood flow in the aboral posterior quadrant of the rectum postoperatively compared to patients operated on using PME. This might explain differing rates of anastomotic leakage.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02401100.
|
|
| 3. |
- Back, Erik, et al.
(författare)
-
Permanent stoma rates after anterior resection for rectal cancer : risk prediction scoring using preoperative variables
- 2021
-
Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 108:11, s. 1388-1395
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A permanent stoma after anterior resection for rectal cancer is common. Preoperative counselling could be improved by providing individualized accurate prediction modelling.METHODS: Patients who underwent anterior resection between 2007 and 2015 were identified from the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine presence of a stoma 2 years after surgery. A training set based on the years 2007-2013 was employed in an ensemble of prediction models. Judged by the area under the receiving operating characteristic curve (AUROC), data from the years 2014-2015 were used to evaluate the predictive ability of all models. The best performing model was subsequently implemented in typical clinical scenarios and in an online calculator to predict the permanent stoma risk.RESULTS: Patients in the training set (n = 3512) and the test set (n = 1136) had similar permanent stoma rates (13.6 and 15.2 per cent). The logistic regression model with a forward/backward procedure was the most parsimonious among several similarly performing models (AUROC 0.67, 95 per cent c.i. 0.63 to 0.72). Key predictors included co-morbidity, local tumour category, presence of metastasis, neoadjuvant therapy, defunctioning stoma use, tumour height, and hospital volume; the interaction between age and metastasis was also predictive.CONCLUSION: Using routinely available preoperative data, the stoma outcome at 2 years after anterior resection for rectal cancer can be predicted fairly accurately.
|
|
| 4. |
- Back, Par-Erik, et al.
(författare)
-
Hållbarhetsanalys i avhjälpandeprocessen för förorenade områden - Principer och lärdomar från forskningsprojektet SAFIRE
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Forskningsprojektet SAFIRE genomfördes under åren 2015–2018. Projektets övergripande syfte var att utvärdera hur hållbarhetsbedömningar kan förbättra effektiviteten vid avhjälpande av föroreningsskador vid förorenade områden i Sverige. Bakgrunden till projektet var bland annat den låga saneringstakten i landet, de ofta höga kostnaderna för avhjälpande åtgärder samt åtgärdernas negativa effekter. Ett viktigt moment i avhjälpandeprocessen är att identifiera det åtgärdsalternativ som är bäst och det är rimligt att denna bedömning baseras på hållbarhet, vilket är det synsätt som tillämpats i forskningsprojektet. I arbetspaketet WP3, Incorporation of sustainability assessment in the remediation process, har lärdomarna från bland annat fallstudier använts för att utvärdera hållbarhetsanalysernas roll i avhjälpandeprocessen. Resultatet av detta arbete presenteras i denna rapport. En viktig slutsats är att arbetet med hållbarhetsanalyser måste komma in tidigt i avhjälpandeprocessen, redan i inledningen av huvudstudien, och hållbarhetsaspekterna bör återspeglas i de övergripande åtgärdsmål som formuleras. Som exempel måste de övergripande åtgärdsmålen lägga en grund för återfyllnadsmassornas kvalitet vid schaktsaneringar, så att en fungerande markmiljö återskapas. En annan slutsats är att det krävs ett iterativt arbetssätt för att en hållbarhetsanalys ska bli framgångsrik. Det innebär att det kan vara nödvändigt att backa till tidigare moment för att modifiera åtgärdsalternativ och samla in kompletterande information. Utgångspunkten i arbetet ska vara att den riskreduktion som krävs ska uppnås på ett så hållbart sätt som möjligt. Det gäller att vara observant på att samtliga efterbehandlingsalternativ verkligen uppfyller kravet på riskreduktion. För flera moment i huvudstudien behöver vägledningar tas fram, med fokus på hållbarhet. Detta gäller bland annat hur övergripande åtgärdsmål formuleras och hur en åtgärdsutredning bör utformas. Tydligare vägledning i dessa och liknande frågor kan i förlängningen bidra till mer hållbara efterbehandlingsåtgärder.
|
|
| 5. |
- Lappalainen, H. K., et al.
(författare)
-
Overview: Recent advances in the understanding of the northern Eurasian environments and of the urban air quality in China - a Pan-Eurasian Experiment (PEEX) programme perspective
- 2022
-
Ingår i: Atmospheric Chemistry and Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 22:7, s. 4413-4469
-
Tidskriftsartikel (refereegranskat)abstract
- The Pan-Eurasian Experiment (PEEX) Science Plan, released in 2015, addressed a need for a holistic system understanding and outlined the most urgent research needs for the rapidly changing Arctic-boreal region. Air quality in China, together with the long-range transport of atmospheric pollutants, was also indicated as one of the most crucial topics of the research agenda. These two geographical regions, the northern Eurasian Arctic-boreal region and China, especially the megacities in China, were identified as a "PEEX region". It is also important to recognize that the PEEX geographical region is an area where science-based policy actions would have significant impacts on the global climate. This paper summarizes results obtained during the last 5 years in the northern Eurasian region, together with recent observations of the air quality in the urban environments in China, in the context of the PEEX programme. The main regions of interest are the Russian Arctic, northern Eurasian boreal forests (Siberia) and peatlands, and the megacities in China. We frame our analysis against research themes introduced in the PEEX Science Plan in 2015. We summarize recent progress towards an enhanced holistic understanding of the land-atmosphere-ocean systems feedbacks. We conclude that although the scientific knowledge in these regions has increased, the new results are in many cases insufficient, and there are still gaps in our understanding of large-scale climate-Earth surface interactions and feedbacks. This arises from limitations in research infrastructures, especially the lack of coordinated, continuous and comprehensive in situ observations of the study region as well as integrative data analyses, hindering a comprehensive system analysis. The fast-changing environment and ecosystem changes driven by climate change, socio-economic activities like the China Silk Road Initiative, and the global trends like urbanization further complicate such analyses. We recognize new topics with an increasing importance in the near future, especially "the enhancing biological sequestration capacity of greenhouse gases into forests and soils to mitigate climate change" and the "socio-economic development to tackle air quality issues".
|
|
| 6. |
- Norrman, Jenny, 1971, et al.
(författare)
-
Enriching social and economic aspects in sustainability assessments of remediation strategies – Methods and implementation
- 2020
-
Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 707
-
Tidskriftsartikel (refereegranskat)abstract
- Over the last decade, there has been rapid development in promoting and implementing sustainable remediation. It is now common to include at least some sustainability considerations in remediation projects. Specific challenges that have been highlighted often relate to economic and social aspects not receiving enough attention: broadening the social aspects, community and meaningful stakeholder engagement, understanding stakeholders' risk perception, and a need for better estimates of site-specific economic costs and benefits. This study presents an application of the Sustainable Choice of REmediation (SCORE) framework with special focus on (1) demonstrating the working process for a broad sustainability assessment and (2) sharing the lessons learned from its application. Specific objectives are to describe (a) the types of stakeholders involved in the assessment, (b) the methods for collection of social and economic sustainability data, (c) residents' perception of risks, (d) the use of the sustainability assessment results in the decision-making process, and (5) possibilities for improving the methods and working process. SCORE was applied and evaluated with input from, and together with, stakeholders at the BT Kemi industrial site in the village of Teckomatorp, south Sweden, a former pesticide production site associated with the most infamous Swedish environmental scandal. A questionnaire (n = 78) was used to collect input from residents regarding local acceptance and economic externalities of the remediation alternatives. Alternatives with a high degree of removal of contaminants received a high ranking in the assessment, primarily due to social and economic effects. The working process can be improved, specifically regarding workshop preparation and workshop structure. A broad representation of stakeholders and early establishment of communication channels to residents is key for robust assessment of social aspects. The information from the sustainability assessment was used in the decision-making process, not least for revising remediation options.
|
|
| 7. |
- Rutegård, Martin, 1982-, et al.
(författare)
-
Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure : nationwide population-based study
- 2023
-
Ingår i: BJS Open. - : Oxford University Press. - 2474-9842. ; 7:3
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Electrolyte disturbances and dehydration are common after anterior resection for rectal cancer with a defunctioning loop ileostomy. High-quality population-based studies on the impact of a defunctioning loop ileostomy on renal failure are lacking.METHODS: This was a nationwide observational study, based on the Swedish Colorectal Cancer Registry of patients undergoing anterior resection for rectal cancer between 2008 and 2016, with follow-up until 2017. Patients with severe co-morbidity, with age greater than 80 years, and with pre-existing renal failure were excluded. Loop ileostomy at index surgery constituted exposure, while a diagnosis of renal failure was the outcome. Acute and chronic events were analysed separately. Inverse probability weighting with adjustment for confounding derived from a causal diagram was employed. Hazards ratios (HRs) with 95 per cent c.i. are reported.RESULTS: A total of 5355 patients were eligible for analysis. At 5-year follow-up, all renal failure events (acute and chronic) were 7.2 per cent and 3.3 per cent in the defunctioning stoma and no stoma groups respectively. In the weighted analysis, a HR of 11.59 (95 per cent c.i. 5.68 to 23.65) for renal failure in ostomates was detected at 1 year, with the largest effect from acute renal failure (HR 24.04 (95 per cent c.i. 8.38 to 68.93)). Later follow-up demonstrated a similar pattern, but with smaller effect sizes.CONCLUSION: Patients having a loop ileostomy in combination with anterior resection for rectal cancer are more likely to have renal failure, especially early after surgery. Strategies are needed, such as careful fluid management protocols, and further research into alternative stoma types or reduction in stoma formation.
|
|
| 8. |
- Volchko, Yevheniya, 1979, et al.
(författare)
-
Assessing costs and benefits of improved soil quality management in remediation projects : A study of an urban site contaminated with PAH and metals
- 2020
-
Ingår i: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 707
-
Tidskriftsartikel (refereegranskat)abstract
- Contaminants in the soil may threaten soil functions (SFs) and, in turn, hinder the delivery of ecosystem services (ES). A framework for ecological risk assessments (ERAs) within the APPLICERA - APPLICable site-specific Environmental Risk Assessment research project promotes assessments that consider other soil quality parameters than only contaminant concentrations. The developed framework is: (i) able to differentiate the effects of contamination on SFs from the effects of other soil qualities essential for soil biota; and (ii) provides a robust basis for improved soil quality management in remediation projects. This study evaluates the socio-economic consequences of remediation alternatives stemming from a Tier 1 ERA that focusses on total contaminant concentrations and soil quality standards and a detailed, site-specific Tier 3 Triad approach that is based on the APPLICERA framework. The present study demonstrates how Tier 1 and Tier 3 ERAs differ in terms of the socio-economic consequences of their remediation actions, as well as presents a novel method for the semi-quantitative assessment of on-site ES. Although the presented Tier 3 ERA is more expensive and time-consuming than the more traditional Tier 1 ERA approach, it has the potential to lower the costs of remediation actions, decrease greenhouse gas emissions, reduce other environmental impacts, and minimise socio-economic losses. Furthermore, the remediation actions stemming from the Tier 3 ERA were predicted to exert far less negative ES effects than the actions proposed based on the results of the Tier 1 ERA.
|
|
