On Atmospheric Energy Transport by Waves

Recently a new method, based on a Fourier decomposition in the zonal direction, for studying the atmospheric energy transport contribution by planetary and cyclone scale waves has been proposed. Recent studies based on this show that planetary waves contribute more than cyclone scale waves to the atmospheric energy transport into the Arctic. The planetary waves contribute to the Arctic amplification through latent heat transport, even when the total atmospheric energy transport is decreasing in model projections. However, the performance of the energy split method to capture transports by cyclone and planetary scale waves has not yet been evaluated. Here an attempt to evaluate the performance of the energy split method is presented. The energy split method is applied on synthetic data, where the wave structure and energy transport are known. This leads to a potential error in the energy split methods resolution of transport associated with synthetic isolated cyclones, transport is contributed to planetary waves in the Fourier spectra. When applied on atmospheric reanalysis data where only isolated cyclones are present in atmospheric state it is evident that more than 80% (70%) of the transport of dry static energy (latent heat) is contributed by planetary waves. From inspections of the vertically integrated energy transport field it is evident that the latent heat transport of cyclones is large compared to the climatology, which implies that there is a problem with the energy split method when the atmospheric state is characterized by an isolated cyclone scale wave, and that the error is especially important to consider for the latent heat transport into the Arctic. Further investigations are proposed to estimate the upper bound of the error introduced in the energy split method

On the linkage between atmospheric circulation changes and Arctic climate change

Polar amplification is a prominent feature of recent and projected climate change. The Arctic region shows some of the strongest signs of climate change, including sea-ice retreat and temperatures increasing at twice the rate averaged over the northern hemisphere. A major concern for humanity is the sea-level rise associated with the melting of the ice-sheets and glaciers due to climate change. The atmospheric circulation transports an amount of energy into to the Arctic equivalent that received by the Arctic from the Sun. Thus, the atmospheric energy transport is an important subject to study in the light of Arctic climate change. The atmospheric energy transport may be decomposed into contributions by planetary-scale waves such as Rossby waves and small-scale waves such as cyclones. The energy transport contributions by the different length-scale separated systems are shown to affect the Arctic differently. The meridional energy transport is separated into length-scale contributions using a Fourier-series-based approach. Here we evaluate this approach by comparing it to a novel wavelet-based length-scale decomposition, developed as a part of this project. Further a machine-learning-based length-scale decomposition approximator is developed. The approximator may be applied to climate model output to investigate future changes in the length-scale decomposed energy transport. From the comparisons it is apparent that both the Fourier and wavelet-based length-scale decompositions are skilled approaches, which produce physically meaningful decompositions. Additionally, the Fourier-based decomposition is further developed to yield a length-scale decomposition on a latitude-longitude grid. Once evaluated the Fourier and wavelet-based decompositions are applied to investigate the effects of recent climate change on the atmospheric energy transport, and how these changes affect the Arctic and the Greenland ice-sheet. Through these studies it is conspicuous that shifts of energy transport between length-scale components has occurred during the last decades, and that these shifts have contributed to Greenland ice-sheet melt and Arctic warming

Vatsa-aorttaan kasvavien kasvaimien onkovaskulaarinen kirurgia

Teema : aorttaOnkovaskulaarikirurgialla tarkoitetaan syöpäkirurgiaa, jossa kasvaimen poistaminen edellyttää myös verisuonien poistamista ja rekonstruktiota. Yhdistämällä eri erikoisalojen osaamista pystytään tarjoamaan kirurgista hoitoa potilaille, joille ei yleensä ole tarjolla muuta, mahdollisesti parantavaa, hoitoa. Toisaalta riskinä on potilaiden altistuminen suurille hyödyttömille ja elämänlaatua huonontaville leikkauksille. Useiden tautiryhmien osalta alkaa olla tietoa siitä, että kasvu verisuoniin ei välttämättä huononna ennustetta eikä ole syy jättää potilasta leikkaamatta. Leikkauspäätös on aina tehtävä moniammatillisesti ja kriittisesti niin, että taudin luonne ja muut hoitovaihtoehdot otetaan huomioon ja hyödynnetään. Leikkaustulokset on käsiteltävä avoimesti ja kriittisesti. Tavallisimmin vatsa-aortan rekonstruktio tulee kysymykseen retroperitoneaalisten sarkoomien ja kivessyöpien etäpesäkkeiden leikkauksen yhteydessä.Peer reviewe

Changes in atmospheric latent energy transport into the Arctic: Planetary versus synoptic scales

Atmospheric meridional energy transport into the Arctic plays an important role in Arctic weather and climate. The transport of latent energy in the form of water vapour strongly influences the Arctic atmosphere. The transport is achieved by circulation mechanisms on various scales and is largely comprised of extreme transport events. Here, we use a Fourier-based method of dividing the latent energy transport into spatial scales and investigate the extent to which extreme events in latent energy transport on planetary and synoptic scales have changed over the past four decades, and how they influence the Arctic winter temperatures. We find that wintertime extreme transport events on planetary scales are associated with warm temperature anomalies across the entire Arctic, while the extreme events on synoptic scales have less impact on the Arctic temperatures. We show that over the past four decades, there has been a significant increase in the wintertime latent energy transport by planetary-scale systems, and a decrease in synoptic-scale transport. This shift may have contributed to the amplified warming observed in the Arctic winter over the past decades

Increasing Prevalence and High Risk of Associated Anomalies in Congenital Vertebral Defects : A Population-based Study

Background: Congenital vertebral anomalies are a heterogeneous group of diagnoses, and studies on their epidemiology are sparse. Our aim was to investigate the national prevalence and mortality of these anomalies, and to identify associated anomalies. Methods: We conducted a population-based nationwide register study and identified all cases with congenital vertebral anomalies in the Finnish Register of Congenital Malformations from 1997 to 2016 including live births, stillbirths, and elective terminations of pregnancy because of major fetal anomalies. Cases were categorized based on the recorded diagnoses, associated major anomalies were analyzed, and prevalence and infant mortality were calculated. Results: We identified 255 cases of congenital vertebral anomalies. Of these, 92 (36%) were diagnosed with formation defects, 18 (7.1%) with segmentation defects, and 145 (57%) had mixed vertebral anomalies. Live birth prevalence was 1.89 per 10,000, and total prevalence was 2.20/10,000, with a significantly increasing trend over time (P < 0.001). Overall infant mortality was 8.2% (18/219); 3.5% (3/86) in patients with formation defects, 5.6% (1/18) in segmentation defects, and 12.2% (14/115) in mixed vertebral anomalies (P = 0.06). Co-occurring anomalies and syndromes were associated with increased mortality, P = 0.006. Majority of the cases (82%) were associated with other major anomalies affecting most often the heart, limbs, and digestive system. Conclusions: In conclusion, the prevalence of congenital vertebral anomalies is increasing significantly in Finnish registers. Detailed and systematic examination is warranted in this patient population to identify underlying comorbidities as the majority of cases are associated with congenital major anomalies.Peer reviewe

IDH1 Expression via the R132H Mutation-Specific Antibody in Adrenocortical Neoplasias-Prognostic Impact in Carcinomas

Context: Mutations to isocitrate dehydrogenase (IDH) appear to play a prognostic or predictive role in several neoplasias. Immunohistochemical staining designed to detect a specific R132H mutation to IDH1 showed expression in the normal adrenal cortex, raising interest to study the potential role of IDH1 in the pathogenesis of adrenocortical tumors. Objective: The objective of this work is to study the role of IDH1 and its mutations in adrenocortical tumors. Design and patients: IDH1 R132H immunohistological staining was performed on a cohort of 197 adrenocortical tumors. The exon of the IDH1 gene was sequenced in 16 tumors. Results: Positive IDH1 R132H immunohistochemical staining correlated with a better prognosis among patients with a malignant adrenocortical tumor. However, IDH1 R132H immunohistochemistry did not distinguish between local and metastasized tumors. We were unable to identify IDH1 mutations among our adrenocortical tumors using a targeted next-generation sequencing panel or via exon sequencing. Conclusions: Among adrenocortical carcinomas, IDH1 R132H immunopositivity correlated with a better prognosis. Thus, IDH1 R132H immunohistochemical staining could serve as a prognostic or as a potential predictive marker in adrenocortical carcinomas. Further research is needed to identify the possible alterations in IDH1 that could explain our findings, because we identified no known mutations to the IDH1 gene. (C) Endocrine Society 2020.Peer reviewe

Erilaistuneen kilpirauhassyövän invaasio hengitysteihin - kuratiivistavoitteinen hoito

English summaryPeer reviewe

Health-Related Quality of Life in Patients with Small Intestine Neuroendocrine Tumors

Background: The prevalence of small intestine neuroendocrine tumors (SI-NETs) is increasing. Disease progression is often slow and treatment options and long-term survival rates have improved, but little is known about health-related quality of life (HRQoL) in these patients. Objective: To assess HRQoL and its predictors in SI-NET patients receiving contemporary treatments. Methods: We measured HRQoL with 15D and SF-36 questionnaires in 134 SI-NET patients and compared the 15D results to those of an age- and gender-standardized sample of the general population (n = 1,153). In the patients, we studied the impact of treatments, Ki-67, liver metastases, circulating tumor markers, comorbidities, and/or socioeconomic factors on HRQoL with linear regression analysis. Results: The mean disease duration of the patients was 81 (4-468) months, 91% had metastatic disease, and 79% received somatostatin analog treatment. Hepatic tumor load was 0% in 44.8%, 25% in 11.2%, respectively. Mean fP-CgA and S-5HIAA concentrations were 15 (1.3-250) and 344 (24-7,470) nmol/L, respectively. Overall, HRQoL was significantly impaired in patients compared to controls (15D score 0.864 +/- 0.105 vs. 0.905 +/- 0.028, p <0.001). SI-NET patients scored worse on 9 of 15 dimensions: sleep, excretion (i. e., bladder and bowel function), depression, distress, vitality, sexual activity (p <0.001), breathing, usual activities, and discomfort and symptoms (p <0.01-0.05). SF-36 scores were impaired and highly correlated with 15D scores (p <0.001). HRQoL was impaired in patients with (n = 85) compared to patients without (n = 49) impaired excretion (0.828 vs. 0.933, p <0.001). In the patient group, number of medications predicted impaired HRQoL. Conclusions: Despite contemporary treatments, SI-NET patients have severely impaired HRQoL, including diarrhea, sleep, depression, vitality, and sexual activity. (c) 2018 S. Karger AG, BaselPeer reviewe