Data from: The relevance of ecological status to ecosystem functions and services in a large boreal lake

1. Environmental conventions aim to protect ecosystem structures and functions to provide goods and services for mankind. The degree of aquatic ecosystem naturalness, or ecological status as it is defined in the Water Framework Directive (WFD) of the European Union, is notionally linked to supplies of ecosystem services. In practice these links have rarely been documented or even investigated and, to justify conservation and management objectives based on the status indicators, it is essential to demonstrate their relationships to ecosystem functions and services. 2. The WFD requires member states to classify their surface waters aiming to achieve good ecological status of water bodies. However, an implicit assumption of the WFD, that the ecosystem functions and services targeted to be protected and maintained are related to the measured status, remains uncertain. 3. Using a time-series dataset covering almost 50 years, we examined the development of ecological status of eight sub-basins of a large boreal lake in response to improved wastewater management and decreasing pollution. We particularly evaluated whether the observed descriptors of biodiversity, ecosystem functions and services were associated with the judgements of ecological status, and hence if the ecological status is a relevant proxy for ecosystem values to be protected. 4. The ecological status of the polluted sub-basins responded consistently to the decreased nutrient and organic loading. Temporal trends in the biological quality elements and water quality were mostly parallel and showed good status roughly simultaneously. Combined ecological status also appeared to predict some features of taxon diversity (profundal macroinvertebrate and phytoplankton richness), ecosystem functions (primary and bacterial production) and ecosystem services (fish catch and reproductive potential of coregonids). 5. Synthesis and applications. We observed that some ecosystem service supplies and taxon diversity increased with increasing ecological status of the lake. Therefore, our results suggest that ecological status estimates based on simple structural characters are relevant to the ultimate management goals of maintaining biodiversity, ecosystem functions and services, and hence might suffice for extensive assessment and monitoring of lake ecosystems

Lake Paijanne ecologica quality ratios Tolonen et al. Fig. 5

Temporal variation of ecological status (1965-2012), expressed as ecological quality ratios, of Lake Paijanne. Ecological quality ratios given separately for different quality elements: water quality, phytoplankton and profundal macroinvertebrates as well as for combined ecological status

Lake Paijanne loading Tolonen et al. Fig. 1

Nutrient and organic loading in northern and central Lake Paijanne, Finland from 1960 to 2012

Lake Paijanne oxygen data Tolonen et al. Fig. 4

Oxygen concentrations in the sub-basins of Lake Paijanne from 1960s to 2012

EQR vs_ecosystem functions & services Tolonen et al. Fig. 6

Data used to draw figure 6 in Tolonen et al. (2014) i.e. combined ecological status in relation to species diversity of a) phytoplankton, b) zooplankton and c) macroinvertebrates, ecosystem functions parameters including d) phytoplankton, e) bacterial and f) zooplankton production, and g) trophic transfer efficiency of phytoplankton to zooplankton production, and ecosystem services related to fisheries h) CPUE gill-net catch of local fishermen and i) density of coregonid larvae

Lake Paijanne TP_TN_data Tolonen et al. Fig_2 & 3

This Excel-table contains data used to result the figures 2 and 3 of the paper: Tolonen et al. 2014. The relevance of ecological status to ecosystem functions and services in a large boreal lake. Journal of Applied Ecology. doi: 10.1111/1365-2664.12245

Thirty years of esophageal cancer surgery in Oulu University Hospital

Abstract Background: Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques. Methods: All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies. Results: Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011–2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008–2010 29.4% and lowest in 2017–2020 1.8%) and in 1-year survival rate (1987–1998 68.4% vs. 2017–2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen. Conclusions: Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay

Minimally invasive esophagectomy learning curves with different types of background experience

Abstract Background: Minimally invasive esophagectomy (MIE) is a complex procedure with learning associated morbidity. The aim was to evaluate the learning curve for MIE focusing on short-term outcomes in two settings: (I) experienced MIE surgeon in new hospital (Hospital 1); (II) surgeons experienced with open esophagectomy and minimally invasive surrogate surgery (Hospital 2). Methods: In Hospital 1 and Hospital 2, on intent-to-treat basis number of MIEs were 132 and 57, respectively. The primary outcomes were major complications and anastomosis leaks. Secondary outcomes were operative time, blood loss, lymph node yield, hospital stay and 1-year mortality. Length of learning curves were analyzed with risk-adjusted cumulative sum (RA-CUSUM) method. Results: In Hospital 1, major complication and anastomosis leak rates were 9.8% and 4.5%, 22.8% and 12.3% in Hospital 2, respectively. In Hospital 1, complication and leak rates remained stable. In Hospital 2, improvement occurred after 34 cases in major complications and 29 cases in leaks. Of secondary outcomes, improvements were seen in Hospital 1 in operative time after 61, blood loss after 86, lymph node yield after 52, hospital stay after 19 and 1-year mortality after 24 cases. In Hospital 2, improvement occurred in operative time after 30, blood loss after 15, lymph node yield after 45, hospital stay after 50 and 1-year mortality after 15 cases. Conclusions: According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase

Preoperative esophageal stenting and 5-year survival in patients undergoing esophagectomy for esophageal cancer:a population-based nationwide study from Finland

Abstract Background: Preoperative esophageal stenting is proposed to have a negative effect on outcomes. The aim was to compare a 5-year survival in patients undergoing esophagectomy for esophageal cancer with and without preoperative esophageal stent in a population-based nationwide cohort from Finland. The secondary outcome was 90-day mortality. Methods: This study included curatively intended esophagectomies for esophageal cancer in Finland between 1999 and 2016, with follow-up until December 31, 2019. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of overall 5-year and 90-day mortality. Model 1 was adjusted for age, sex, year of the surgery, comorbidities, histology, pathological stage, and neoadjuvant therapy. Model 2 included also albumin level and BMI. Result: Of 1064 patients, a total of 134 patients underwent preoperative stenting and 930 did not. In both adjusted models 1 and 2, higher 5-year mortality was seen in patients with preoperative stent with HRs of 1.29 (95% CI 1.00–1.65) and 1.25 (95% CI 0.97–1.62), respectively, compared to no stenting. The adjusted HR of 90-day mortality was 2.49 (95% CI 1.27–4.87) in model 1 and 2.49 (95% CI 1.25–4.99) in model 2. When including only neoadjuvant-treated patients, those with preoperative stent had a 5-year survival of 39.2% compared to 46.4% without stent (adjusted HR 1.34, 95% CI 1.00–1.80), and a 90-day mortality rate of 8.5% and 2.5% (adjusted HR 3.99, 95% CI 1.51–10.50). Discussion: This nationwide study reports worse 5-year and 90-day outcomes in patients with preoperative esophageal stent. Since residual confounding remains possible, observed difference could be only an association rather than the cause