Invasive intraductal papillary mucinous neoplasm and pancreatic ductal adenocarcinoma : a comparison in clinicopathology and long-term outcome

Background: The resections for both pre-malignant and invasive intraductal papillary mucinous neoplasm (inv-IPMN) have increased the last decades. Long term outcome, and the impact of adjuvant chemotherapy, non-regional lymph node status and recurrence pattern on overall survival (OS) is known for conventional pancreatic ductal adenocarcinoma (PDAC), but not so for inv-IPMN. Aims: I) Investigate differences and similarities in clinicopathology and overall survival between patients resected for inv-IPMN and PDAC. II) Elucidate whether the raised numbers of pancreatic resections for inv-IPMN in combination with the improvement in OS recent years have influenced outcome. III) Assess the prognostic significance of para-aortal lymph node (PALN) involvement in patients resected for inv-IPMN and PDAC in the pancreatic head. IV) Explore the impact of adjuvant chemotherapy and spatio-temporal recurrence pattern on overall survival for inv-IPMN compared with PDAC. Methods: All studies were retrospective observational studies of consecutive patients ≥ 18 years of age resected for inv-IPMN and PDAC. Study I-III were single-centre studies of in total 515 patients resected at Karolinska University Hospital between 2009-2018, Study IV was a national multi-centre study of patients resected in Sweden between 2010–2019. Clinicopathological variables were analysed in multivariable Cox regression models. Outcome was assessed by calculating two- or three-year OS rate and estimating OS using the Kaplan-Meier model. Survival functions were compared with log-rank test. In study I were clinicopathological variables also analysed in multivariable logistic regression models. Study II only comprised patients with PDAC or inv-IPMN in the pancreatic head who underwent partial or total pancreatoduodenectomy including PALN resection. In study III, that only included patients residing in the Stockholm area, different initial recurrence sites and time frames as well as predictors for death including the impact of adjuvant chemotherapy were assessed with multivariable logistic and Cox regressions. In study IV, clinicopathological variables were retrieved from the Swedish national pancreatic and periampullary cancer registry. The effect on death was assessed in two multivariable Cox regression models, one for patients resected 2010-2015, one for patients resected 2016-2019. Results: In study I, 513 patients were included, 122 inv-IPMN and 391 PDAC. The proportion resected inv-IPMN and two-year OS increased during the study period. In Kaplan-Meier survival analysis, inv-IPMN had more favourable median OS compared to PDAC. In multivariable Cox Regression analysis, tumour type was not a predictor for death. In study II, 403 patients were included, 89 inv-IPMN and 314 PDAC. PALN were metastatic in 16% and there was no difference between the groups. N0- and N2-stage were present in 16% and 53% respectively for patients with inv-IPMN compared to 6% and 65% respectively for patients with PDAC (p=0.007). Median OS was 12.7 and 22.7 months in the presence or absence of PALN metastases respectively (p<0.001), and similar in N2-stage regardless the presence of PALN status. PALN status was not an independent prognostic factor. In study III, 396 patients were included, 92 inv-IPMN and 304 PDAC. Both recurrence rate and death rate within three-years were lower for inv-IPMN compared to PDAC. The most common recurrence patterns were multi-site (25%), single-site liver (21%) and single-site locoregional (10%) recurrence. The most important predictors for death were multi-site, single-site peritoneal and single-site liver recurrence. These predictors were less common in inv-IPMN compared to PDAC. Adjuvant chemotherapy had similar effect in the two groups. In study IV, 1909 patients were included, 293 inv-IPMN and 1616 PDAC. Tumour type was an independent predictor for death in the 2016-2019 cohort, but not in the 2010-2015 cohort. In Kaplan-Meier survival analysis, inv-IPMN was associated with longer median OS in stage N0-1 and in stage M0 compared to PDAC. However, in stage T2-4 and stage N2 median OS was similar, whereas median OS in stage M1 was even shorter for inv-IPMN compared to PDAC. Conclusions: Inv-IPMN seemed to have favourable survival outcome compared to PDAC in lower stages, and similar to worse in higher. Outcome was dependent on the combination of a pronounced increase in resected inv-IPMN and a concurrent hazard reduction for death within 2 years during the study period. PALN status is not an independent risk factor for death and does not influence survival in N2-staged disease. The M1-stage for PALN positivity may therefore need reconsideration. Resected inv-IPMN exhibited a less aggressive recurrence pattern than PDAC that translated into a more favourable overall survival

Ungulate use of an at-grade fauna passage and roadside animal detection system: A pilot study from Southern Sweden

Wildlife-vehicle collisions (WVC) cost millions of euros each year in loss of life and damages. Wildlife crossing structures and fencing are commonly implemented mitigation strategies to reduce WVC and increase landscape connectivity for wildlife. Typically, crossing structures are over- or under-pass structures that allow animals to safely cross the road, while separating them from the road and traffic. An alternative strategy could be an at-grade fauna passage coupled with a Roadside Animal Detection System (RADS). At-grade fauna passages are designated locations where a gap in fencing allows animals to cross over the road, while RADS alert drivers of animals at the upcoming passage, so that they can adjust their driving behaviour accordingly and avoid collisions. In this pilot study, we investigated the use of one at-grade fauna passage by roe deer (Capreolus capreolus), red deer (Cervus elaphus) and wild boar (Sus scrofa) in southern Sweden, and compared changes in the number of WVCs before, during and after the construction of the passage. We collected a total of 326 wildlife crossings from 722 individuals over 1 year of monitoring (24 January 2020-24 January 2021). We found that crossing events tended to be dominated by the time animals spent in the roadside verge from which they approached the at-grade fauna passage, particularly for roe deer that spent a lot of time browsing in the roadside verge during dusk. We also found that animals spent longer in the passage if vehicles were present. In our 1 year of surveys, we only recorded three accidents, and when comparing the annual collision statistics before, during, and after construction of the at-grade fauna passage, we demonstrated an overall reduction in collisions by 66%. While our pilot only evaluates a single site, it does provide promising preliminary results that suggest that at-grade fauna passages can help in efforts to reduce collisions, while maintaining connectivity over medium-sized roads for large ungulates

Secondary effects of the COVID-19 pandemic on surgical management of hepatopancreatobiliary malignancies in the Nordic capitals

Non peer reviewe

Estimating the regional distribution of men who have sex with men (MSM) based on Internet surveys

<p>Abstract</p> <p>Background</p> <p>Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. Population-based surveys have recently been used to estimate the total number of MSM, but these surveys are usually not large enough to measure regional differences in the proportion of MSM in the population. We explored the use of the proportional regional distribution of participants of large internet-based surveys among MSM from Germany to estimate the regional distribution of MSM in Germany.</p> <p>Methods</p> <p>We compared participants from two separate MSM behavioural surveys with each other and with the distribution of user profiles of the largest contact and dating website for gay and other MSM in Germany in terms of the representativeness of the regional distribution. In addition, we compared the regional distribution of reportedly HIV positive survey participants with the regional distribution of HIV notifications within the national surveillance system that can be attributed to transmission through homosexual contacts.</p> <p>Results</p> <p>Regional distribution of survey participants was almost identical in both surveys, despite little overlap between survey participants. Slight discrepancies between surveys and user profiles could be observed. Proportional regional distribution of survey participants with HIV diagnosis resembled national surveillance data.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain representative data by other sampling methods for "hidden" populations like MSM, internet-based surveys may provide an easy and low cost tool to estimate the regional population distribution – at least in Western post-industrialized countries. Some uncertainties remain about the exact place of residence of MSM in larger cities or catchment areas of these cities. Slightly different results from different datasets may be due to unequal popularity of MSM websites in different regions. The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys. Both estimates can then be combined to calculate the absolute size of regional MSM populations.</p

Beginning of activity in 67P/Churyumov-Gerasimenko and predictions for 2014–2015

Context. Comet 67P/Churyumov-Gerasimenko was selected in 2003 as the new target of the Rosetta mission. It has since been the subject of a detailed campaign of observations to characterise its nucleus and activity. Aims. We present previously unpublished data taken around the start of activity of the comet in 2007/8, before its last perihelion passage. We constrain the time of the start of activity, and combine this with other data taken throughout the comet’s orbit to make predictions for its likely behaviour during 2014/5 while Rosetta is operating. Methods. A considerable difficulty in observing 67P during the past years has been its position against crowded fields towards the Galactic centre for much of the time. The 2007/8 data presented here were particularly difficult, and the comet will once again be badly placed for Earth-based observations in 2014/5. We make use of the difference image analysis technique, which is commonly used in variable star and exoplanet research, to remove background sources and extract images of the comet. In addition, we reprocess a large quantity of archival images of 67P covering its full orbit, to produce a heliocentric lightcurve. By using consistent reduction, measurement and calibration techniques we generate a remarkably clean lightcurve, which can be used to measure a brightness-distance relationship and to predict the future brightness of the comet. Results. We determine that the comet was active around November 2007, at a pre-perihelion distance from the Sun of 4.3 AU. The comet will reach this distance, and probably become active again, in March 2014. We find that the dust brightness can be well described by Afρ ∝ r-3.2 pre-perihelion and ∝ r-3.4 post-perihelion, and that the comet has a higher dust-to-gas ratio than average, with log (Afρ/Q(H2O)) = − 24.94 ± 0.22 cm s molecule-1 at r < 2 AU. A model fit to the photometric data suggests that only a small fraction (1.4%) of the surface is active

Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care

Speech Communication

Contains table of contents for Part IV, table of contents for Section 1 and reports on five research projects.Apple Computer, Inc.C.J. Lebel FellowshipNational Institutes of Health (Grant T32-NS07040)National Institutes of Health (Grant R01-NS04332)National Institutes of Health (Grant R01-NS21183)National Institutes of Health (Grant P01-NS23734)U.S. Navy / Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Office of Naval Research (Contract N00014-82-K-0727

Speech Communication

Contains reports on five research projects.C.J. Lebel FellowshipNational Institutes of Health (Grant 5 T32 NSO7040)National Institutes of Health (Grant 5 R01 NS04332)National Institutes of Health (Grant 5 R01 NS21183)National Institutes of Health (Grant 5 P01 NS13126)National Institutes of Health (Grant 1 PO1-NS23734)National Science Foundation (Grant BNS 8418733)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0341)U.S. Navy - Naval Electronic Systems Command (Contract N00039-85-C-0290)National Institutes of Health (Grant RO1-NS21183), subcontract with Boston UniversityNational Institutes of Health (Grant 1 PO1-NS23734), subcontract with the Massachusetts Eye and Ear Infirmar

The supernatural characters and powers of sacred trees in the Holy Land

This article surveys the beliefs concerning the supernatural characteristics and powers of sacred trees in Israel; it is based on a field study as well as a survey of the literature and includes 118 interviews with Muslims and Druze. Both the Muslims and Druze in this study attribute supernatural dimensions to sacred trees which are directly related to ancient, deep-rooted pagan traditions. The Muslims attribute similar divine powers to sacred trees as they do to the graves of their saints; the graves and the trees are both considered to be the abode of the soul of a saint which is the source of their miraculous powers. Any violation of a sacred tree would be strictly punished while leaving the opportunity for atonement and forgiveness. The Druze, who believe in the transmigration of souls, have similar traditions concerning sacred trees but with a different religious background. In polytheistic religions the sacred grove/forest is a centre of the community's official worship; any violation of the trees is regarded as a threat to the well being of the community. Punishments may thus be collective. In the monotheistic world (including Christianity, Islam and Druze) the pagan worship of trees was converted into the worship/adoration of saints/prophets; it is not a part of the official religion but rather a personal act and the punishments are exerted only on the violating individual