| 21. |
- Gleeson, Elizabeth M., et al.
(författare)
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Failure to Rescue After Pancreatoduodenectomy : A Transatlantic Analysis
- 2021
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Ingår i: Annals of Surgery. - 1528-1140. ; 274:3, s. 459-466
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This analysis aimed to compare failure to rescue (FTR) after pancreatoduodenectomy across the Atlantic. SUMMARY BACKGROUND DATA: FTR, or mortality after development of a major complication, is a quality metric originally created to compare hospital results. FTR has been studied in North American and Northern European patients undergoing pancreatoduodenectomy (PD). However, a direct comparison of FTR after PD between North America and Northern Europe has not been performed. METHODS: Patients who underwent PD in North America, the Netherlands, Sweden and Germany (GAPASURG dataset) were identified from their respective registries (2014-17). Patients who developed a major complication defined as Clavien-Dindo ≥3 or developed a grade B/C postoperative pancreatic fistula (POPF) were included. Preoperative, intraoperative, and postoperative variables were compared between patients with and without FTR. Variables significant on univariable analysis were entered into a logistic regression for FTR. RESULTS: Major complications occurred in 6188 of 22,983 patients (26.9%) after PD, and 504 (8.1%) patients had FTR. North American and Northern European patients with complications differed, and rates of FTR were lower in North America (5.4% vs 12%, P < 0.001). Fourteen factors from univariable analysis contributing to differences in patients who developed FTR were included in a logistic regression. On multivariable analysis, factors independently associated with FTR were age, American Society of Anesthesiology ≥3, Northern Europe, POPF, organ failure, life-threatening complication, nonradiologic intervention, and reoperation. CONCLUSIONS: Older patients with severe systemic diseases are more difficult to rescue. Failure to rescue is more common in Northern Europe than North America. In stable patients, management of complications by interventional radiology is preferred over reoperation.
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| 22. |
- Grema, Haruna M., et al.
(författare)
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The Formation of Highly Positive δ34S Values in Late Devonian Mudstones: Microscale Analysis of Pyrite (δ34S) and Barite (δ34S, δ18O) in the Canol Formation (Selwyn Basin, Canada)
- 2022
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Ingår i: Frontiers in Earth Science. - : Frontiers Media SA. - 2296-6463. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- The sulfur isotope composition of pyrite in marine sedimentary rocks is often difficult to interpret due to a lack of precise isotopic constraints for coeval sulfate. This study examines pyrite and barite in the Late Devonian Canol Formation (Selwyn Basin, Canada), which provides an archive of δ34S and δ18O values during diagenesis. Scanning electron microscopy (SEM) has been combined with microscale secondary ion mass spectrometry (SIMS) analysis (n = 1,032) of pyrite (δ34S) and barite (δ34S and δ18O) on samples collected from nine stratigraphic sections of the Canol Formation. Two paragenetic stages of pyrite and barite formation have been distinguished, both replaced by barium carbonate and feldspar. The δ34Sbarite and δ18Obarite values from all sections overlap, between +37.1‰ and +67.9‰ (median = +45.7‰) and +8.8‰ and +23.9‰ (median = +20.0‰), respectively. Barite morphologies and isotopic values are consistent with precipitation from diagenetically modified porewater sulfate (sulfate resupply << sulfate depletion) during early diagenesis. The two pyrite generations (Py-1 and Py-2) preserve distinct textures and end-member isotopic records. There is a large offset from coeval Late Devonian seawater sulfate in the δ34Spyrite values of framboidal pyrite (-29.4‰ to -9.3‰), consistent with dissimilatory microbial sulfate reduction (MSR) during early diagenesis. The Py-2 is in textural equilibrium with barite generation 2 (Brt-2) and records a broad range of more positive δ34SPy-2 values (+9.4‰ to + 44.5‰). The distinctive highly positive δ34Spyrite values developed from sulfate limited conditions around the sulfate methane transition zone (SMTZ). We propose that a combination of factors, including low sulfate concentrations, MSR, and sulfate reduction coupled to anaerobic oxidation of methane (SR-AOM), led to the formation of highly positive δ34Spyrite and δ34Sbarite values in the Canol Formation. The presence of highly positive δ34Spyrite values in other Late Devonian sedimentary units indicate that diagenetic pyrite formation at the SMTZ may be a more general feature of other Lower Paleozoic basins.
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| 23. |
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| 24. |
- Jasechko, S., et al.
(författare)
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Late-glacial to late-Holocene shifts in global precipitation delta O-18
- 2015
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Ingår i: Climate of the Past. - : Copernicus GmbH. - 1814-9324 .- 1814-9332. ; 11:10, s. 1375-1393
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Tidskriftsartikel (refereegranskat)abstract
- Reconstructions of Quaternary climate are often based on the isotopic content of paleo-precipitation preserved in proxy records. While many paleo-precipitation isotope records are available, few studies have synthesized these dispersed records to explore spatial patterns of late-glacial precipitation delta O-18. Here we present a synthesis of 86 globally distributed groundwater (n = 59), cave calcite (n = 15) and ice core (n = 12) isotope records spanning the late-glacial (defined as similar to 50 000 to similar to 20 000 years ago) to the late-Holocene (within the past similar to 5000 years). We show that precipitation delta O-18 changes from the late-glacial to the late-Holocene range from -7.1% (delta O-18(late-Holocene) > delta O-18(late-glacial)) to + 1.7% (delta O-18(late-glacial) > delta O-18(late-Holocene)), with the majority (77 %) of records having lower late-glacial delta O-18 than late-Holocene delta O-18 values. High-magnitude, negative precipitation delta O-18 shifts are common at high latitudes, high altitudes and continental interiors (delta O-18(late-Holocene) > delta O-18(late-glacial) by more than 3 %). Conversely, low-magnitude, positive precipitation delta O-18 shifts are concentrated along tropical and subtropical coasts (delta O-18(late-glacial) > delta O-18(late-Holocene) by less than 2 %). Broad, global patterns of late-glacial to late-Holocene precipitation delta O-18 shifts suggest that stronger-than-modern isotopic distillation of air masses prevailed during the late-glacial, likely impacted by larger global temperature differences between the tropics and the poles. Further, to test how well general circulation models reproduce global precipitation delta O-18 shifts, we compiled simulated precipitation delta O-18 shifts from five isotope-enabled general circulation models simulated under recent and last glacial maximum climate states. Climate simulations generally show better intermodel and model-measurement agreement in temperate regions than in the tropics, highlighting a need for further research to better understand how inter-model spread in convective rainout, seawater delta O-18 and glacial topography parameterizations impact simulated precipitation delta O-18. Future research on paleo-precipitation delta O-18 records can use the global maps of measured and simulated late-glacial precipitation isotope compositions to target and prioritize field sites.
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| 25. |
- Latenstein, Anouk E.J., et al.
(författare)
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The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden
- 2021
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 170:2, s. 563-570
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Tidskriftsartikel (refereegranskat)abstract
- Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014–2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo ≥3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume <40 or high-volume ≥40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P <.001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P <.001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P <.001). Country, age ≥75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P =.002), but not in Germany (9.8% vs 10.6%; P =.733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.
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| 26. |
- Mackay, Tara M., et al.
(författare)
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Transatlantic registries of pancreatic surgery in the United States of America, Germany, the Netherlands, and Sweden : Comparing design, variables, patients, treatment strategies, and outcomes
- 2020
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Registries of pancreatic surgery have become increasingly popular as they facilitate both quality improvement and clinical research. We aimed to compare registries for design, variables collected, patient characteristics, treatment strategies, clinical outcomes, and pathology. Methods: Registered variables and outcomes of pancreatoduodenectomy (2014–2017) in 4 nationwide or multicenter pancreatic surgery registries from the United States of America (American College of Surgeons National Surgical Quality Improvement Program), Germany (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie - Studien-, Dokumentations- und Qualitätszentrum), the Netherlands (Dutch Pancreatic Cancer Audit), and Sweden (Swedish National Pancreatic and Periampullary Cancer Registry) were compared. A core registry set of 55 parameters was identified and evaluated using relative and absolute largest differences between extremes (smallest versus largest). Results: Overall, 22,983 pancreatoduodenectomies were included (15,224, 3,558, 2,795, and 1,406 in the United States of America, Germany, the Netherlands, and Sweden). Design of the registries varied because 20 out of 55 (36.4%) core parameters were not available in 1 or more registries. Preoperative chemotherapy in patients with pancreatic ductal adenocarcinoma was administered in 27.6%, 4.9%, 7.0%, and 3.4% (relative largest difference 8.1, absolute largest difference 24.2%, P < .001). Minimally invasive surgery was performed in 7.8%, 4.5%, 13.5%, and unknown (relative largest difference 3.0, absolute largest difference 9.0%, P < .001). Median length of stay was 8.0, 16.0, 12.0, and 11.0 days (relative largest difference 2.0, absolute largest difference 8.0, P < .001). Reoperation was performed in 5.7%, 17.1%, 8.7%, and 11.2% (relative largest difference 3.0, absolute largest difference 11.4%, P < .001). In-hospital mortality was 1.3%, 4.7%, 3.6%, and 2.7% (relative largest difference 3.6, absolute largest difference 3.4%, P < .001). Conclusion: Considerable differences exist in the design, variables, patients, treatment strategies, and outcomes in 4 Western registries of pancreatic surgery. The absolute largest differences of 24.3% for the use of preoperative chemotherapy, 9.0% for minimally invasive surgery, 11.4% for reoperation rate, and 3.4% for in-hospital mortality require further study and improvement. This analysis provides 55 core parameters for pancreatic surgery registries.
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| 27. |
- Rosenhahn, Erik, et al.
(författare)
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Bi-allelic loss-of-function variants in PPFIBP1 cause a neurodevelopmental disorder with microcephaly, epilepsy, and periventricular calcifications
- 2022
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Ingår i: American Journal of Human Genetics. - : Cell Press. - 0002-9297 .- 1537-6605. ; 109:8, s. 1421-1435
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Tidskriftsartikel (refereegranskat)abstract
- PPFIBP1 encodes for the liprin-β1 protein, which has been shown to play a role in neuronal outgrowth and synapse formation in Drosophila melanogaster. By exome and genome sequencing, we detected nine ultra-rare homozygous loss-of-function variants in 16 individuals from 12 unrelated families. The individuals presented with moderate to profound developmental delay, often refractory early-onset epilepsy, and progressive microcephaly. Further common clinical findings included muscular hyper- and hypotonia, spasticity, failure to thrive and short stature, feeding difficulties, impaired vision, and congenital heart defects. Neuroimaging revealed abnormalities of brain morphology with leukoencephalopathy, ventriculomegaly, cortical abnormalities, and intracranial periventricular calcifications as major features. In a fetus with intracranial calcifications, we identified a rare homozygous missense variant that by structural analysis was predicted to disturb the topology of the SAM domain region that is essential for protein-protein interaction. For further insight into the effects of PPFIBP1 loss of function, we performed automated behavioral phenotyping of a Caenorhabditis elegans PPFIBP1/hlb-1 knockout model, which revealed defects in spontaneous and light-induced behavior and confirmed resistance to the acetylcholinesterase inhibitor aldicarb, suggesting a defect in the neuronal presynaptic zone. In conclusion, we establish bi-allelic loss-of-function variants in PPFIBP1 as a cause of an autosomal recessive severe neurodevelopmental disorder with early-onset epilepsy, microcephaly, and periventricular calcifications.
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| 28. |
- Soligard, Torbjorn, et al.
(författare)
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How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury
- 2016
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:17, s. 1030-1041
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Tidskriftsartikel (refereegranskat)abstract
- Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.
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| 29. |
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| 30. |
- Davis, Catherine H., et al.
(författare)
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Impact of Neoadjuvant Therapy for Pancreatic Cancer : Transatlantic Trend and Postoperative Outcomes Analysis
- 2024
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Ingår i: Journal of the American College of Surgeons. - : LIPPINCOTT WILLIAMS & WILKINS. - 1879-1190 .- 1072-7515. ; 238:4, s. 613-621
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN: Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed. RESULTS: Overall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p < 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p < 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection. CONCLUSIONS: NAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.
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