| 1. |
- Bass, Gary Alan, 1979-, et al.
(author)
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Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study
- 2023
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In: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 17-32
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Journal article (peer-reviewed)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
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| 2. |
- Bécoulet, A., et al.
(author)
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Science and technology research and development in support to ITER and the Broader Approach at CEA
- 2013
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In: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 53:10
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Journal article (peer-reviewed)abstract
- In parallel to the direct contribution to the procurement phase of ITER and Broader Approach, CEA has initiated research & development programmes, accompanied by experiments together with a significant modelling effort, aimed at ensuring robust operation, plasma performance, as well as mitigating the risks of the procurement phase. This overview reports the latest progress in both fusion science and technology including many areas, namely the mitigation of superconducting magnet quenches, disruption-generated runaway electrons, edge-localized modes (ELMs), the development of imaging surveillance, and heating and current drive systems for steady-state operation. The WEST (W Environment for Steady-state Tokamaks) project, turning Tore Supra into an actively cooled W-divertor platform open to the ITER partners and industries, is presented.
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| 3. |
- Forssten, Maximilian Peter, 1996-, et al.
(author)
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Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
- 2023
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In: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 57-67
-
Journal article (peer-reviewed)abstract
- Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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| 4. |
- Janko, Matthew, et al.
(author)
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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
- 2021
-
In: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 76, s. 202-210
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection.METHODS: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed.RESULTS: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01)CONCLUSION: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
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| 5. |
- Bath, Jonathan, et al.
(author)
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Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
- 2023
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In: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 77:5, s. 1339-1348.e6
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Journal article (peer-reviewed)abstract
- Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
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| 6. |
- Gunnarsson, Carina, et al.
(author)
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Ökad användning av restströmmar från spannmålsodling för en svensk biobaserad ekonomi
- 2022
-
Reports (other academic/artistic)abstract
- Det finns ett stort intresse att använda halm i bioraffinaderiprocesser för att producera förnybara material, kemikalier och drivmedel, men mängden halm är begränsad och aktuella processer är ofta storskaliga. Målet med detta projekt var att bidra till ökad användning av tillgängliga restströmmar från spannmålsproduktion och därmed bidra till ökad andel inhemsk råvara till den svenska biobaserade industrin. Projektet undersökte tre restströmmar från spannmålsproduktionen: halm, rensverksfraktion (från tröskans rensverk som normalt sprids ut på fältet och inte samlas in) samt avrens från rensmaskiner och aspiratörer på spannmålsmottagningar. Arbetet innefattade att karakterisera olika sorters halm, utvärdera tekniker för att öka insamlingsgraden vid skörd, lagringsförsök samt modellering av leveranssäkerhet och skördestrategier. Ett speciellt fokus var att utvärdera materialet med avseende på biogasproduktion. Den grundläggande karakteriseringen som gjordes av halm och rensverksfraktion från höstvete, korn, havre, höstråg och höstraps visade vissa skillnader i innehåll av cellulosa, hemicellulosa, lignin, oorganiska ämnen samt extraktivämnen, men inga som kunde förklara skillnaderna i metanproduktionen mellan proverna. Råghalm hade den högsta metanproduktionen, medan halm från höstraps hade signifikant lägre metanproduktion än de andra halmsorterna. Metanproduktionen från rensverksfraktionerna visade samma tendens som för halmen. För att försöka hitta förklaringar till den lägre metanproduktionen för halm och rensverksfraktion från höstraps gjordes kompletterande analyser av biomassans struktur och sammansättning. Inga tydliga skillnader i cellullosakristallinitet kunde ses som skulle kunna förklara den lägre biogasproduktionen. De fördjupade analyserna kunde visa att det finns skillnader i ligninstruktur, det skulle dock behöva undersökas vidare om dessa bidrar till skillnaderna i metanproduktionen. En hypotes som inte kunde bekräftas är att höstrapshalmen innehåller glukosinulater som när de bryts ner kan verka hämmande på bakterierna i jäsningsprocessen. Detta behöver utredas vidare i kommande studier. I projektet utvärderades två olika tekniker för att förutom halm även samla in rensverksfraktion och därigenom öka mängden bärgat material. Vid skörd av spannmål samlas kärnan i en tank, medan halmen och övriga överjordiska delar av spannmålsplantan som återstår matas ut efter skördetröskan. Utvärderingen visade att total insamlad mängd biomassa ökade när även rensverksfraktionen samlades in. Även halmbalarnas densitet ökade vid inblandning av rensverksfraktionen i halmen, vilket är fördelaktigt för transporteffektiviteten. Ökningen av insamlad mängd och baldensitet var dock signifikant i endast ett av de två försöken. Mellan 36 % och 41 % av den teoretiskt bärgningsbara mängden biomassa samlades inte in och kan betraktas som förluster i systemet. Vissa av förlusterna går att åtgärda med val av maskiner som är väl anpassade till varandra medan andra kräver ett helt annat skördesystem. Potentialen för utveckling av nya och förbättrade tekniska system som möjliggör att en större andel biomassa kan tillvaratas är därför stor. Tillgången på halm för användning i bioraffinaderier kan även ökas genom att använda halm av olika kvalitet, tex fuktig halm. I tre olika lagringsförsök undersöktes under vilka förutsättningar det finns risk för förluster under aeroba förhållanden. Försöken utvärderades med avseende på effekten på förluster och kvalitet samt metanproduktion. Respirometerförsök genomfördes på halm och rensverksfraktion från höstvete och korn vid två olika vattenaktiviteter (vattenhalter) under ca 2 månader. Resultaten visade att förlusterna hos höstvetehalm troligen kan hållas låga om den lagras vid en vattenhalt under 20-23 %. Kornhalm verkar vara något känsligare och kan behöva vara några procentenheter torrare, medan rensverksfraktionen verkar vara något mer motståndskraftig mot mikrobiell tillväxt. I vetehalm ökade metanpotentialen under lagringen, medan den minskade för halm och rensverksfraktion från korn. Den stora minskningen i metanpotential för kornproverna kan ha orsakats av de högre kvävehalterna och lägre C/N kvot som gynnar mikrobiell aktivitet. Resultaten tyder på att fuktig aerob lagring av vetehalm kan fungera som ett förbehandlingssteg där cellulosanedbrytande mögelsvampar bryter ned cellulosan och därmed gör kolet mer tillgänglig för de metangasproducerande mikroorganismerna. Studien tyder på att denna process går snabbare med kornhalm. Dessa resultat behöver följas upp och fördjupas. Genom att utnyttja lagringstiden till biologisk förbehandling inför användning i bioraffinaderiet kan vi på ett positivt sätt utnyttja faktorer som normalt har negativ inverkan på kvalitet, såsom hög fukthalt och temperatur samt långa lagringstider. I fullskaliga försök som upprepades under två år vid Gasum AB biogasanläggning i Jordberga utvärderades avrenslagring under praktiska förhållande i stora plansilor utan täckning. Lagringsförsöket genomfördes med avrensat material (avrens) från i spannmålshandelns mottagningsanläggningar. Lagringsprocessen övervakades på olika djup genom mätningar av gassammansättning och temperatur och lagringsförlusterna bestämdes. Förlusterna av torrsubstans under lagringen varierade mellan 1,5 och 3 %, dock med undantag från ytprovet år två där förlusterna uppgick till 63 %. De höga förlusterna i ytprovet beror sannolikt på en längre lagringstid i kombination med direkt exponering mot atmosfäriska förhållanden och därmed nederbörd. Detta resulterade i en omfattande tillväxt av mögelsvampar. Metanpotentialen i proverna från ytan var båda åren signifikant lägre (8 % respektive 62 %) än i proverna från inläggningen. Mellan djupare liggande prover fanns ingen signifikant skillnad i metanpotential sinsemellan eller jämfört med inläggningsprovet. Låg vattenhalt, syrefattiga förhållanden och höga temperaturer hämmade mikrobiell tillväxt i djupare liggande prover. Den modelleringsstudie baserad på väderdata som genomfördes med syftet att under-söka hur leveranssäkerheten av halm påverkas av väderleken visade att mängden torr halm som kan bärgas varierar stort mellan år. Andelen av den tillgängliga mängden halm som i genomsnitt över flera år är möjlig att bala (pressningskoefficient) beräknades till 84, 86, 82 och 80 % för Västmanland, Östergötland, Västra Götaland respektive Skåne vid maximalt 18% vattenhalt vid pressning. Den varierade även över skördesäsongen. Den tillgängliga pressningstiden minskade från över 50 % i den andra halvan av juli till under 30 % i de första veckorna i oktober beroende på område. De genomsnittliga andelarna pressad halm varierade för de enskilda grödorna: den var högst för höstvete, ca 90 % för gårdarna belägna i Västmanland, Östergötland och Västra Götaland, och 80 % i Skåne. Andelarna för vårvete var lägst, 67–75 % beroende på område.
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| 7. |
- Janko, Matthew R., et al.
(author)
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In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement
- 2022
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In: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 76:2, s. 546-
-
Journal article (peer-reviewed)abstract
- Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P <.001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P <.001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective.
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| 8. |
- Moffatt, Clare, et al.
(author)
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International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum
- 2023
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In: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 95, s. 23-31
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch.METHODS: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions.RESULTS: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change.CONCLUSIONS: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
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| 9. |
- Reijneveld, Jaap C, et al.
(author)
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Health-related quality of life in patients with high-risk low-grade glioma (EORTC 22033-26033) : a randomised, open-label, phase 3 intergroup study.
- 2016
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In: The Lancet Oncology. - 1470-2045 .- 1474-5488. ; 17:11, s. 1533-1542
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Journal article (peer-reviewed)abstract
- BACKGROUND: Temozolomide chemotherapy versus radiotherapy in patients with a high-risk low-grade glioma has been shown to have no significant effect on progression-free survival. If these treatments have a different effect on health-related quality of life (HRQOL), it might affect the choice of therapy. We postulated that temozolomide compromises HRQOL and global cognitive functioning to a lesser extent than does radiotherapy.METHODS: We did a prospective, phase 3, randomised controlled trial at 78 medical centres and large hospitals in 19 countries. We enrolled adult patients (aged ≥18 years) with histologically confirmed diffuse (WHO grade II) astrocytoma, oligodendroglioma, or mixed oligoastrocytoma, with a WHO performance status of 2 or lower, without previous chemotherapy or radiotherapy, who needed active treatment other than surgery. We randomly assigned eligible patients (1:1) using a minimisation technique, stratified by WHO performance status (0-1 vs 2), age (<40 years vs ≥40 years), presence of contrast enhancement on MRI, chromosome 1p status (deleted vs non-deleted vs indeterminate), and the treating medical centre, to receive either radiotherapy (50·4 Gy in 28 fractions of 1·8 Gy for 5 days per week up to 6·5 weeks) or temozolomide chemotherapy (75 mg/m(2) daily, for 21 of 28 days [one cycle] for 12 cycles). The primary endpoint was progression-free survival (results published separately); here, we report the results for two key secondary endpoints: HRQOL (assessed using the European Organisation for Research and Treatment of Cancer's [EORTC] QLQ-C30 [version 3] and the EORTC Brain Cancer Module [QLQ-BN20]) and global cognitive functioning (assessed using the Mini-Mental State Examination [MMSE]). We did analyses on the intention-to-treat population. This study is closed and is registered at EudraCT, number 2004-002714-11, and at ClinicalTrials.gov, number NCT00182819.FINDINGS: Between Dec 6, 2005, and Dec 21, 2012, we randomly assigned 477 eligible patients to either radiotherapy (n=240) or temozolomide chemotherapy (n=237). The difference in HRQOL between the two treatment groups was not significant during the 36 months' follow-up (mean between group difference [averaged over all timepoints] 0·06, 95% CI -4·64 to 4·75, p=0·98). At baseline, 32 (13%) of 239 patients who received radiotherapy and 32 (14%) of 236 patients who received temozolomide chemotherapy had impaired cognitive function, according to the MMSE scores. After randomisation, five (8%) of 63 patients who received radiotherapy and three (6%) of 54 patients who received temozolomide chemotherapy and who could be followed up for 36 months had impaired cognitive function, according to the MMSE scores. No significant difference was recorded between the groups for the change in MMSE scores during the 36 months of follow-up.INTERPRETATION: The effect of temozolomide chemotherapy or radiotherapy on HRQOL or global cognitive functioning did not differ in patients with low-grade glioma. These results do not support the choice of temozolomide alone over radiotherapy alone in patients with high-risk low-grade glioma.FUNDING: Merck Sharp & Dohme-Merck & Co, National Cancer Institute, Swiss Cancer League, National Institute for Health Research, Cancer Research UK, Canadian Cancer Society Research Institute, National Health and Medical Research Council, European Organisation for Research and Treatment of Cancer Cancer Research Fund.
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| 10. |
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| 11. |
- Back, Erik, et al.
(author)
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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
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In: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 406:6, s. 1971-1977
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Journal article (peer-reviewed)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.
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| 12. |
- Back, Erik, et al.
(author)
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Permanent stoma rates after anterior resection for rectal cancer : risk prediction scoring using preoperative variables
- 2021
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In: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 108:11, s. 1388-1395
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Journal article (peer-reviewed)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.
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| 13. |
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| 14. |
- Back, Tom, et al.
(author)
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Glomerular Filtration Rate After Alpha-Radioimmunotherapy with At-211-MX35-F(ab ')(2): A Long-Term Study of Renal Function in Nude Mice
- 2009
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In: Cancer Biotherapy & Radiopharmaceuticals. - : Mary Ann Liebert Inc. - 1557-8852 .- 1084-9785. ; 24:6, s. 649-658
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Journal article (peer-reviewed)abstract
- Besides bone marrow, the kidneys are often dose-limiting organs in internal radiotherapy. The effects of high-linear energy transfer (LET) radiation on the kidneys after alpha-radioimmunotherapy (alpha-RIT) with the alpha-particle emitter, At-211, were studied in nude mice by serial measurements of the glomerular filtration rate (GFR). The renal toxicity was evaluated at levels close to the dose limit for the bone marrow and well within the range for therapeutic efficacy on tumors. Astatinated MX35-F(ab ')(2) monoclonal antibodies were administered intravenously to nude mice. Both non-tumor-bearing animals and animals bearing subcutaneous xenografts of the human ovarian cancer cell line, OVCAR-3, were used. The animals received approximately 0.4, 0.8, or 1.2MBq in one, two, or three fractions. The mean absorbed doses to the kidneys ranged from 1.5 to 15 Gy. The renal function was studied by serial GFR measurements, using plasma clearance of Cr-51-EDTA, up to 67 weeks after the first astatine injection. A dose-dependent effect on GFR was found and at the time interval 8-30 weeks after the first administration of astatine, the absorbed doses causing a 50% decrease in GFR were 16.4 +/- 3.3 and 14.0 +/- 4.1 Gy (mean +/- SEM), tumor-and non-tumor-bearing animals, respectively. The reduction in GFR progressed with time, and at the later time interval, (31-67 weeks) the corresponding absorbed doses were 7.5 +/- 2.4 and 11.3 +/- 2.3 Gy, respectively, suggesting that the effects of radiation on the kidneys were manifested late. Examination of the kidney sections showed histologic changes that were overall subdued. Following a-RIT with 211 At-MX35-F(ab')(2) at levels close to the dose limit of severe myelotoxicity, the effects found on renal function were relatively small, with only minor to moderate reductions in GFR. These results suggest that a mean absorbed dose to the kidneys of approximately 10Gy is acceptable, and that the kidneys would not be the primary dose-limiting organ in systemic a-RIT when using At-211-MX35-F(ab')(2).
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| 15. |
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| 16. |
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| 17. |
- Edgecock, T. R., et al.
(author)
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High intensity neutrino oscillation facilities in Europe
- 2013
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In: Physical Review Special Topics - Accelerators and Beams. - : American Physical Society. - 1098-4402. ; 16:2, s. 021002-
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Journal article (peer-reviewed)abstract
- The EUROnu project has studied three possible options for future, high intensity neutrino oscillation facilities in Europe. The first is a Super Beam, in which the neutrinos come from the decay of pions created by bombarding targets with a 4 MW proton beam from the CERN High Power Superconducting Proton Linac. The far detector for this facility is the 500 kt MEMPHYS water Cherenkov, located in the Frejus tunnel. The second facility is the Neutrino Factory, in which the neutrinos come from the decay of mu(+) and mu(-) beams in a storage ring. The far detector in this case is a 100 kt magnetized iron neutrino detector at a baseline of 2000 km. The third option is a Beta Beam, in which the neutrinos come from the decay of beta emitting isotopes, in particular He-6 and Ne-18, also stored in a ring. The far detector is also the MEMPHYS detector in the Frejus tunnel. EUROnu has undertaken conceptual designs of these facilities and studied the performance of the detectors. Based on this, it has determined the physics reach of each facility, in particular for the measurement of CP violation in the lepton sector, and estimated the cost of construction. These have demonstrated that the best facility to build is the Neutrino Factory. However, if a powerful proton driver is constructed for another purpose or if the MEMPHYS detector is built for astroparticle physics, the Super Beam also becomes very attractive.
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| 18. |
- Ersson, Back Tomas, et al.
(author)
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Simulated productivity of one- and two-armed tree planting machines
- 2013
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In: Silva Fennica. - : Finnish Society of Forest Science. - 0037-5330 .- 2242-4075. ; 47:2
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Journal article (peer-reviewed)abstract
- To increase mechanized planting, planting machine productivity must increase in order to improve cost-efficiency. To determine if excavators with two crane arms could potentially help to increase planting machine productivity under Nordic clearcut conditions, we modelled one- armed and semi-automated two-armed excavators with one- and two-headed planting devices. Using a recently developed tool for discrete-event simulation, these machine models then mounded and planted seedlings on terrain models with moraine soil having various frequencies of obstacles (stumps, roots and stones). Compared to if the two heads were mounted pairwise on only one arm, the results showed that productivity did not increase if two planting heads were attached individually to two separate crane arms. But productivity did increase if the planting machine had four planting heads mounted pairwise on two separate arms. However, despite assuming automated mounding and crane motion between planting spots, the two-armed, four- headed model never achieved high enough productivity levels to make it more cost-efficient than one-armed machines. The simulations illustrate that our terrain models generate realistic root architecture and boulder content distributions in moraine soil, while our machine models functionally describe mechanized planting work. Based on our assumptions, we conclude that further development work on two-armed excavator-based planting machines for Nordic clearcut conditions is not warranted. Our simulations reveal that increasing the number of planting heads per crane arm rather than number of crane arms per base machine offers the greatest potential to raise the productivity of intermittently advancing planting machines.
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| 19. |
- Ersson, Back Tomas, et al.
(author)
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Simulations of Mechanized Planting : Modelling Terrain and Crane-Mounted Planting Devices
- 2012
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In: OSCAR 2012. - : Latvian State Forest Research Institute "Silava". ; , s. 15-19
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Conference paper (other academic/artistic)abstract
- When reforesting clearcuts in southern Sweden, the Bracke Planter has shown to plant seedlings with better planting quality than operational manual tree planting (Ersson and Petersson 2011). Consequently, there is an increasing demand for intermittently advancing tree planting machines with crane-mounted planting devices in southern Sweden.Nevertheless, regardless of using one- (Bracke Planter) or two-headed planting devices (M-Planter), today’s average planting machine productivity is still too low (Rantala and Laine 2010, Ersson et al. 2011) for planting machines to cost-wise compete with manual tree planting in southern Sweden (Ersson 2010). There is, therefore, a need to develop new planting machines concepts that are significantly more productive on Nordic terrain, i.e. clearcuts on moraine soils with varying prevalences of stones and stumps where the slash has been harvested for bioenergy.For over 40 years, simulation studies have proven useful for testing prospective forest machine concepts (e.g. (Sjunnesson 1970)), including different types of planting heads (Andersson et al. 1977). In particular, simulations studies can nowadays help to cost-efficiently evaluate new ideas before real world implementation (Jundén 2011). However, previous forest machine simulations simplified terrain characteristics like stumps, roots and stones to the extent that these models are too simplistic for meaningful planting machine simulations. For this reason, we have built several terrain, base machine and planting device models for use during discrete-event simulations to test potential solutions that realistically might increase Nordic planting machine productivity. These simulations were performed using a simulator built with the SimPy discrete-event simulation language (Jundén 2011).TERRAIN MODELSPresently, our terrain models encompass stumps, roots and underground stones. To delineate the clearcuts, we used Herlitz’s (1975) type stands for clearcutting. These type stands also provided theinput data necessary for sizing and spatially allocating the stumps. To all stumps, we attached a root plate according to the deterministic data from Björkhem et al. (1975) and a stochastic root architecture inspired by Kalliokoski et al.’s (2010) root models.As concluded already during the 1960s (Bäckström 1978), the presence of non-visible, underground stones and boulders is what makes mechanized reforestation on moraine soils so difficult. To model this difficulty, we used parameter values from Andersson et al. (1977) to define incidences of stones and boulders (boulder quota or stoniness) and mean stone sizes. Then, we chose an exponential distribution to link stone frequency to stone diameter. In accordance with Eriksson and Holmgren (1996), our modelled stones are spherical in shape and are spatially allocated in a random manner.BASE MACHINE MODELSToday’s planting machines use excavators as base machines. If using standard components, it might be techno-economically feasible to add another arm to the excavator; thereby creating two- (Fig. 2) or four-headed planting machines where planting head interdependence is minimized. We hypothesized that the productivity of two-armed planting machines, compared to normal one-armed machines, might especially be higher on obstacle-rich terrain since one arm could be free to move while the other arm is busy working. Moreover, two-armed machines might particularly benefit from additional task automation. Preliminary results, however, show that this productivity increase might not be high enough to warrant further development of our two-armed planting machine concept.PLANTING DEVICE MODELSWe modelled today’s two most common planting devices, the one-headed Bracke Planter and the two-headed M-Planter. During simulation, the planting machine operator searches sequentially for microsites free from visible obstacles (stumps and main lateral roots). However, both devices can be impeded by underground roots or stones during mounding, and by stones during the planting phase. Striking obstacles with the M-Planter can result in delays for one or both heads.FURTHER DEVELOPMENTWe are currently expanding the terrain models to include humus layers and surface boulders, on which new multi-headed planting device concepts (with two to four planting heads) with obstacle-avoiding capabilities are being tested. Those simulation results will provide guidance as to how future crane-mounted planting devices should behave and be designed in order to increase planting machine productivity.
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| 20. |
- Henning, G., et al.
(author)
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Exploring the stability of super heavy elements: First measurement of the fission barrier of 254No
- 2014
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In: EPJ Web of Conferences. - : EDP Sciences. - 2101-6275 .- 2100-014X. ; 66
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Conference paper (peer-reviewed)abstract
- The gamma-ray multiplicity and total energy emitted by the heavy nucleus 254No have been measured at 2 different beam energies. From these measurements, the initial distributions of spin I and excitation energy E * of 254No were constructed. The distributions display a saturation in excitation energy, which allows a direct determination of the fission barrier. 254No is the heaviest shell-stabilized nucleus with a measured fission barrier. © Owned by the authors, published by EDP Sciences, 2014.
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| 21. |
- Henning, G., et al.
(author)
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Fission Barrier of Superheavy Nuclei and Persistence of Shell Effects at High Spin: Cases of No-254 and Th-220
- 2014
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In: Physical Review Letters. - 1079-7114 .- 0031-9007. ; 113:26
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Journal article (peer-reviewed)abstract
- We report on the first measurement of the fission barrier height in a heavy shell-stabilized nucleus. The fission barrier height of No-254 is measured to be B-f = 6.0 +/- 0.5 MeV at spin 15 (h) over bar and, by extrapolation, B-f = 6.6 +/- 0.9 MeV at spin 0 (h) over bar. This information is deduced from the measured distribution of entry points in the excitation energy versus spin plane. The same measurement is performed for Th-220 and only a lower limit of the fission barrier height can be determined: B-f (I) > 8 MeV. Comparisons with theoretical fission barriers test theories that predict properties of superheavy elements.
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| 22. |
- Jurns, John, et al.
(author)
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Waste Heat Recovery from the European Spallation Source Cryogenic Helium Plants - Implications for System Design
- 2014
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In: Advances in Cryogenic Engineering: Transactions of the Cryogenic Engineering Conference - CEC (AIP Conference Proceedings). - : AIP Publishing LLC. - 1551-7616 .- 0094-243X. ; 1573, s. 647-654
-
Conference paper (peer-reviewed)abstract
- The European Spallation Source (ESS) neutron spallation project currently being designed will be built outside of Lund, Sweden. The ESS design includes three helium cryoplants, providing cryogenic cooling for the proton accelerator superconducting cavities, the target neutron source, and for the ESS instrument suite. In total, the cryoplants consume approximately 7 MW of electrical power, and will produce approximately 36 kW of refrigeration at temperatures ranging from 2-16 K. Most of the power consumed by the cryoplants ends up as waste heat, which must be rejected. One hallmark of the ESS design is the goal to recycle waste heat from ESS to the city of Lund district heating system. The design of the cooling system must optimize the delivery of waste heat from ESS to the district heating system and also assure the efficient operation of ESS systems. This report outlines the cooling scheme for the ESS cryoplants, and examines the effect of the cooling system design on cryoplant design, availability and operation.
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| 23. |
- Lappalainen, Hanna K., et al.
(författare)
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Pan-Eurasian Experiment (PEEX) : towards a holistic understanding of the feedbacks and interactions in the land-atmosphere-ocean-society continuum in the northern Eurasian region
- 2016
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Ingår i: Atmospheric Chemistry And Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 16:22, s. 14421-14461
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Tidskriftsartikel (refereegranskat)abstract
- The northern Eurasian regions and Arctic Ocean will very likely undergo substantial changes during the next decades. The Arctic-boreal natural environments play a crucial role in the global climate via albedo change, carbon sources and sinks as well as atmospheric aerosol production from biogenic volatile organic compounds. Furthermore, it is expected that global trade activities, demographic movement, and use of natural resources will be increasing in the Arctic regions. There is a need for a novel research approach, which not only identifies and tackles the relevant multi-disciplinary research questions, but also is able to make a holistic system analysis of the expected feedbacks. In this paper, we introduce the research agenda of the Pan-Eurasian Experiment (PEEX), a multi-scale, multi-disciplinary and international program started in 2012 (https://www.atm.helsinki.fi/peex/). PEEX sets a research approach by which large-scale research topics are investigated from a system perspective and which aims to fill the key gaps in our understanding of the feedbacks and interactions between the land-atmosphereaquatic-society continuum in the northern Eurasian region. We introduce here the state of the art for the key topics in the PEEX research agenda and present the future prospects of the research, which we see relevant in this context.
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| 24. |
- Lopez-Martens, A., et al.
(författare)
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Stability and synthesis of superheavy elements: Fighting the battle against fission - example of No-254
- 2016
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Ingår i: EPJ Web of Conferences. - : EDP Sciences. - 2101-6275 .- 2100-014X. - 9782759890118 ; 131
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Konferensbidrag (refereegranskat)abstract
- Superheavy nuclei exist solely due to quantum shell effects, which create a pocket in the potential-energy surface of the nucleus, thus providing a barrier against spontaneous fission. Determining the height of the fission barrier and its angular-momentum dependence is important to quantify the role that microscopic shell corrections play in enhancing and extending the limits of nuclear stability. In this talk, the first measurement of a fission barrier in the very heavy nucleus No-254 will be presented.
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| 25. |
- Rutegård, Martin, 1982-, et al.
(författare)
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Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure : nationwide population-based study
- 2023
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Ingår i: BJS Open. - : Oxford University Press. - 2474-9842. ; 7:3
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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.
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