General thoracic surgery in Finland, a perspective from the Helsinki University Hospital

The field of thoracic surgery is a rapidly developing field due to exciting developments in technology and oncologic treatments as well as continuous innovation in surgical technique. Although the population of Finland is relatively small, general thoracic surgery is represented at a high level in five centralized university centers, Helsinki University Hospital, Tampere University Hospital, Turku University Hospital, Kuopio University Hospital and Oulu University Hospital. Thus, high case volume and good results are achieved in these centers. Here, we describe a short history, current state and future prospects of the field of cardiothoracic surgery in Finland, with a focus on general thoracic surgery and the perspective of Helsinki University Hospital. From the field's birth in Finland, marked by the first lobectomy, in the late 1930's, it has grown and adapted more and more modern techniques such as totally minimally invasive esophagectomy and robotic lung cancer surgery. Nowadays, most of general thoracic surgery in Helsinki University Hospital is either minimally invasive or robotic and open surgery is the exception to the norm. Helsinki University Hospital has a strong presence in the European general thoracic surgery community and aims to do so in the future by investing on training & education, research and surgical innovation.Peer reviewe

Energizing collaborative industry‑academia learning: a present case and future visions

In Industry-Academia Collaborations (IAC) both academic, scientific research results and industrial practitioner findings and experiences are produced. Both types of knowledge should be gathered, codified, and disseminated efficiently and effectively. This paper investigates a recent (2014-2017) large-scale IAC R&D&I program case (Need for Speed, N4S) from a learning perspective. It was one of the programs in the Finnish SHOK (Strategic Centres of Science, Technology, and Innovation) system. The theoretical bases are in innovation management, knowledge management, and higher education (university) pedagogy. In the future, IAC projects should be more and more commonplace since major innovations are hardly ever done in isolation, not even by the largest companies. Both intra-organizational and inter-organizational learning networks are increasingly critical success factors. Collaborative learning capabilities will thus be required more often from all the participating parties. Efficient and effective knowledge creation and sharing are underpinning future core competencies. In this paper, we present and evaluate a collaboratively created and publicly shared digital knowledge repository called "Treasure Chest" produced during our case program. The starting point was a jointly created Strategic Research and Innovation Agenda (SRIA), which defined the main research themes and listed motivating research questions to begin with-i.e., intended learning outcomes (ILO). During the 4-year program, our collaborative industry-academia (I-A) learning process produced a range of theoretical and empirical results, which were iteratively collected and packaged into the Treasure Chest repository. Outstandingly, it contained, in addition to traditional research documents, narratives of the industrial learning experiences and more than 100 actionable knowledge items. In conclusion, our vision of the future is that such transparently shared, ambitious, and versatile outcome goals with a continuous integrative collection of the results are keys to effective networked I-A collaboration and learning. In that way, the N4S largely avoided the general problem of often conflicting motives between industrial firms seeking answers and applied solutions to their immediate practical problems and academic researchers aiming at more generalizable knowledge creation and high-quality scientific publications.Peer reviewe

Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer : a retrospective cohort study

Background: Nutritional deficits, cachexia, and sarcopenia are extremely common in esophageal cancer. The aim of this article was to assess the effect of loss of skeletal muscle mass during neoadjuvant treatment on the prognosis of esophageal cancer patients. Methods: Esophageal cancer patients (N = 115) undergoing neoadjuvant therapy and surgery between 2010 and 2014 were identified from our surgery database and retrospectively analyzed. Computed tomography imaging of the total cross-sectional muscle tissue measured at the third lumbar level defined the skeletal muscle index, which defined sarcopenia (SMI <52.4 cm2/m2 for men and <38.5 cm2/m2 for women). Images were collected before and after neoadjuvant treatments. Results: Sarcopenia in preoperative imaging was prevalent in 92 patients (80%). Median overall survival was 900 days (interquartile range 334-1447) with no difference between sarcopenic (median = 900) and non-sarcopenic (median = 914) groups (p = 0.872). Complication rates did not differ (26.1% vs 32.6%, p = 0.725). A 2.98% decrease in skeletal muscle index during neoadjuvant treatment correlated with poor 2-year survival (log-rank p = 0.04). Conclusion: Loss of skeletal muscle tissue during neoadjuvant treatment correlates with worse overall survival.Peer reviewe

Continuous and collaborative technology transfer : Software engineering research with real-time industry impact

Context: Traditional technology transfer models rely on the assumption that innovations are created in academia, after which they are transferred to industry using a sequential flow of activities. This model is outdated in contemporary software engineering research that is done in close collaboration between academia and industry and in large consortia rather than on a one-on-one basis. In the new setup, research can be viewed as continuous co-experimentation, where industry and academia closely collaborate and iteratively and jointly discover problems and develop, test, and improve solutions. Objective: The objective of the paper is to answer the following research questions: How can high-quality, ambitious software engineering research in a collaborative setup be conducted quickly and on a large scale? How can real-time business feedback to continuously improve candidate solutions be gained? Method: The proposed model has been created, refined, and evaluated in two large, national Finnish software research programs. For this paper, we conducted thematic interviews with representatives of four companies who participated in these programs. Results: The fundamental change is in the mindset of the participants from technology push by academia to technology pull by companies, resulting in co-creation. Furthermore, continuous cooperation between participants enables solutions to evolve in rapid cycles and forms a scalable model of interaction between research institutes and companies. Conclusions: The multifaceted nature of software engineering research calls for numerous approaches. In particular, when working with human-related topics such as company culture and development methods, many discoveries result from seamless collaboration between companies and research institutes.Peer reviewe

Hand-sewn versus stapled anastomoses for esophagectomy: We will probably never know which is better

Cited by: 4; All Open Access, Gold Open Access, Green Open AccessPeer reviewe

Ruokatorvisyöpäpotilaan ravitsemushäiriöt

Vertaisarvioitu. English summaryRavitsemushäiriöt ovat tyypillinen ruokatorvisyöpäpotilaiden ongelma, ja niiden seulonnan tulisi olla rutiinimaista kyseisessä potilasryhmässä. Keskeisiä patofysiologisia tekijöitä ovat kasvaimen aiheuttama ruokatorven mekaaninen ahtautuminen, kiihtynyt katabolia, psyykkiset tekijät ja hoitojen aiheuttamat haitat. Ravitsemushäiriöt heikentävät ruokatorvisyöpäpotilaiden ennustetta ja elämänlaatua sekä lisäävät leikkaus- ja solunsalpaajahoitoihin liittyviä haittoja. Enteraalisen lisäravinnon ja ravitsemusneuvonnan tarjoaminen ovat ensisijaisia vajaaravitsemuksen ehkäisy- ja hoitokeinoja. Jos ravinnon saanti suun kautta ei onnistu, voidaan turvautua väliaikaisesti suonensisäiseen ravitsemukseen. Oireinen nielemisvaikeus pystytään hoitamaan tehokkaasti joko ruokatorvistenttauksella, perkutaanisen endoskooppisen gastrostomian (PEG) laittamisella tai pikaisella esiliitännäishoitojen aloittamisella. Ravitsemushäiriöt ovat tavallisia myös parantavien hoitojen jälkeen, ja potilaiden ravitsemustilan seuranta on keskeistä.Peer reviewe

Surgically Treated Unsuspected N2-Positive NSCLC : Role of Extent and Location of Lymph Node Metastasis

The role of positive lymph node location in non-small-cell lung cancer (NSCLC) patients and effects on survival was assessed. A total of 88 operated patients with unsuspected N2 disease or station 10 lymph nodes were included. No difference was found in survival between inferior positive mediastinal N2 node patients compared to multilevel N2 disease patients. The survival of patients with positive hilar disease was similar to the inferior mediastinal positive N2 group. Background: The role of surgery in the treatment of non-small-cell lung cancer that has spread to ipsilateral mediastinal or hilar lymph nodes (LNs) is controversial. We examined whether the location of LNs positive for non-small-cell lung cancer in mediastinum or hilum influences the survival of these patients. Patients and Methods: We reviewed data from 881 patients and analyzed those with unsuspected N2 disease or hilar (station 10) LNs. The patients were stratified into the following groups: group A, positive hilar Naruke 10; group B, superior mediastinal and aortic nodes (Naruke 1, 2, 3, 4, 5, and 6); group C, inferior mediastinal nodes (Naruke 7, 8, and 9), and multilevel group D (2 or more positive N2 levels). Results: A total of 69 pN2 and 19 pN1 patients were included. Progression-free survival (PFS) was statistically significant better in group B versus group C (P = .044) and group B versus group D (P = .0086). The overall survival (OS) of group A did not differ from that of group C. A statistically significant better OS was found between groups B and D (P= .051). Conclusion: Inferior positive mediastinal N2 node patients seem to have an OS and PFS as poor as multilevel N2 disease patients. The OS and PFS of patients with positive hilar disease are similar to those in the inferior mediastinal positive N2 group. Superior positive mediastinal N2 node patients have better OS and PFS than the inferior mediastinal positive N2 group. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Health-related quality of life after laparoscopic repair of giant paraesophageal hernia : how does recurrence in CT scan compare to clinical success?

Background Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life. Methods All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life. Results The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%). Conclusions Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.Peer reviewe

Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center

ObjectivesWe conducted this retrospective study to characterize the change in chronic lymphocytic leukemia (CLL) treatment patterns between 2005 and 2019, to understand the treatment sequencing across the course of the disease, and to investigate how targeted agents and prognostic testing were implemented into the patient care.MethodsThis study included adult patients with CLL treated at the Hospital District of Southwest Finland during the study period. Data were collected from the Turku University Hospital data lake.ResultsIn total, 122 and 60 patients received first- and second-line treatments for CLL, respectively. The shift from conventional chemoimmunotherapy to targeted treatments in recent years (2014–2019) was observed. The median overall survival times were not reached in patients treated with targeted agents compared to conventional standard treatments in first- and second-line settings and improved toward the end of the study period. Prognostic testing increased during the study follow-up and patients with unmutated immunoglobulin heavy-chain variable showed significantly poorer overall survival and time-to-next-treatment outcomes than patients with mutated immunoglobulin heavy-chain variable.ConclusionsThis real-world study implicated added value of targeted chemo-free therapies as reported in randomized clinical trials, and highlighted the necessity of prognostic testing in order to improve treatment selection and patient outcomes.</p

Arthroscopic partial meniscectomy for a degenerative meniscus tear : a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

Objectives To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up. Design Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial. Setting Orthopaedic departments in five public hospitals in Finland. Participants 146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised. Interventions APM or placebo surgery (diagnostic knee arthroscopy). Main outcome measures We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade >= 1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function ( Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale). Results There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade >= 1 of 13%, 95% CI -2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), -1.7 (95% CI -7.7 to 4.3) in WOMET, -2.1 (95% CI -6.8 to 2.6) in Lysholm knee score, and -0.04 (95% CI -0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar. Conclusions APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.Peer reviewe