Complications in lymph node excision in the head and neck area

Background Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. Aims/Objectives This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. Materials and methods Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. Results The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. Conclusions and significance Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.Peer reviewe

Vegetation structure and photosynthesis respond rapidly to restoration in young coastal fens

Young coastal fens are rare ecosystems in the first stages of peatland succession. Their drainage compromises their successional development toward future carbon (C) reservoirs. We present the first study on the success of hydrological restoration of young fens. We carried out vegetation surveys at six young fens that represent undrained, drained, and restored management categories in the Finnish land uplift coast before and after restoration. We measured plant level carbon dioxide (CO2) assimilation and chlorophyll fluorescence (Fv/Fm) from 17 most common plant species present at the sites. Within 5 years of restoration, the vegetation composition of restored sites had started to move toward the undrained baseline. The cover of sedges increased the most in response to restoration, while the cover of deciduous shrubs decreased the most. The rapid response indicates high resilience and low resistance of young fen ecosystems toward changes in hydrology. Forbs had higher photosynthetic and respiration rates than sedges, deciduous shrubs, and grasses, whereas rates were lowest for evergreen shrubs and mosses. The impact of management category on CO2 assimilation was an indirect consequence that occurred through changes in plant species composition: Increase in sedge cover following restoration also increased the potential photosynthetic capacity of the ecosystem. Synthesis and applications. Restoration of forestry drained young fens is a promising method for safeguarding them and bringing back their function as C reservoirs. However, their low resistance to water table draw down introduces a risk that regeneration may be partially hindered by the heavy drainage in the surrounding landscape. Therefore, restoration success is best safeguarded by managing the whole catchments instead of carrying out small-scale projects.Peer reviewe

Mire margin to expanse gradient in part relates to nutrients gradient:evidence from successional mire basins, north Finland

Abstract To study the relationship between mire vegetation and ecological variables we tested the Finnish hypothesis that the mire margin to expanse gradient in vegetation composition relates to a gradient of solutes (main plant nutrients) in the soil that is separate from the mainly pH related poor–rich gradient. Successional mire basins where mire margin to expanse is the prominent gradient were surveyed. An indirect method (Ellenberg indicator values) and direct measurements (phosphorous concentrations, pH) were used to assess the relationship between the mire margin to expanse and nutrients gradients. Vegetation with indicators of Subtype A mire margin vegetation (assumed to reflect surface water flow) correlated best with Ellenberg nitrogen values, whereas Subtype B (assumed to reflect groundwater influence) correlated best with Ellenberg reaction values. Subtype C (supposed to reflect mineral soil influence) did not correlate with these Ellenberg values. The study provides information about the complexity of the vegetational gradients. In general, water flow seems to be related to the poor–rich gradient, but surface water flow is also related to the nutrients gradient. Subtype C (influence of mineral soil) seems to differ from the other two subtypes of the mire margin to expanse gradient and also from the poor–rich gradient. It is prominent on forested sites, where the water table is comparatively deep

Isolation precautions cause minor delays in diagnostics and treatment of non-COVID patients

Publisher Copyright: © 2021Background: Isolation precautions are essential prevent spread of COVID-19 infection but may have a negative impact on inpatient care. The impact of these measures on non-COVID-19 patients remains largely unexplored. Aim: This study aimed to investigate diagnostic and treatment delays related to isolation precautions, the associated patient outcome, and the predisposing risk factors for delays. Methods: This observational study was conducted in seven Helsinki region hospitals during the first wave of the COVID-19 pandemic in Finland. The study used data on all non-COVID-19 inpatients, who were initially isolated due to suspected COVID-19, to estimate whether isolation precautions resulted in diagnostic or treatment delays. Results: Out of 683 non-COVID-19 patients, 33 (4.8%) had delays related to isolation precautions. Clinical condition deteriorated non-fatally in seven (1.0%) patients. The following events were associated with an increased risk of treatment or a diagnostic delay: more than three ward transfers (P = 0.025); referral to an incorrect speciality in the emergency department (P = 0.004); more than three SARS-CoV-2 RT-PCR tests performed (P = 0.022); and where cancer was the final diagnosis (P = 0.018). In contrast, lower respiratory tract symptoms (P = 0.013) decreased the risk. Conclusions: The use of isolation precautions for patients who did not have COVID-19 had minor negative effects on patient outcomes. The present study underlines the importance of targeting diagnostic efforts to patients with unspecified symptoms and to those with a negative SARS-CoV-2 test result. Thorough investigations to achieve an accurate diagnosis improves the prognosis of patients and facilitates appropriate targeting of hospital resources.Peer reviewe

Unmanned aircraft system (UAS) structure-from-motion (SfM) for monitoring the changed flow paths and wetness in minerotrophic peatland restoration

Abstract Peatland restoration aims to achieve pristine water pathway conditions to recover dispersed wetness, water quality, biodiversity and carbon sequestration. Restoration monitoring needs new methods for understanding the spatial effects of restoration in peatlands. We introduce an approach using high-resolution data produced with an unmanned aircraft system (UAS) and supported by the available light detection and ranging (LiDAR) data to reveal the hydrological impacts of elevation changes in peatlands due to restoration. The impacts were assessed by analyzing flow accumulation and the SAGA Wetness Index (SWI). UAS campaigns were implemented at two boreal minerotrophic peatland sites in degraded and restored states. Simultaneously, the control campaigns mapped pristine sites to reveal the method sensitivity of external factors. The results revealed that the data accuracy is sufficient for describing the primary elevation changes caused by excavation. The cell-wise root mean square error in elevation was on average 48 mm when two pristine UAS campaigns were compared with each other, and 98 mm when each UAS campaign was compared with the LiDAR data. Furthermore, spatial patterns of more subtle peat swelling and subsidence were found. The restorations were assessed as successful, as dispersing the flows increased the mean wetness by 2.9–6.9%, while the absolute changes at the pristine sites were 0.4–2.4%. The wetness also became more evenly distributed as the standard deviation decreased by 13–15% (a 3.1–3.6% change for pristine). The total length of the main flow routes increased by 25–37% (a 3.1–8.1% change for pristine), representing the increased dispersion and convolution of flow. The validity of the method was supported by the field-determined soil water content (SWC), which showed a statistically significant correlation (R² = 0.26–0.42) for the restoration sites but not for the control sites, possibly due to their upslope catchment areas being too small. Despite the uncertainties related to the heterogenic soil properties and complex groundwater interactions, we conclude the method to have potential for estimating changed flow paths and wetness following peatland restoration