The prognostic value of extramural venous invasion in preoperative MRI of rectal cancer patients

Aim This study aimed to examine the prognostic value of extramural venous invasion observed in preoperative MRI on survival and recurrences. Method In total, 778 rectal cancer patients were evaluated in multidisciplinary meetings in Helsinki University Hospital during the years 2016-2018. 635 patients met the inclusion criteria of stage I-III disease and were intended for curative treatment at the time of diagnosis. 128 had extramural venous invasion in preoperative MRI. Results The median follow-up time was 2.5 years. In a univariate analysis extramural venous invasion was associated with poorer disease-specific survival (hazard ratio [HR] 2.174, 95% CI 1.118-4.224, P = 0.022), whereas circumferential margin = T3c or nodal positivity were not. Disease recurrence occurred in 17.3% of the patients: 13.4% had metastatic recurrence only, 1.7% mere local recurrence and 2.2% both metastatic and local recurrence. In multivariate analysis, extramural venous invasion (HR 1.734, 95% CI 1.127-2.667, P = 0.012) and nodal positivity (HR 1.627, 95% CI 1.071-2.472, P = 0.023) were risk factors for poorer disease-free survival (DFS). Circumferential marginPeer reviewe

Association of Clinical Factors with the Costs of Kidney Transplantation in the Current Era

Background: Kidney transplantation is reported to save costs compared to maintenance dialysis. We analyzed the current actual costs of kidney transplantation compared to dialysis, and analyzed risk factors for higher costs after transplantation. Material/Methods: Altogether, 338 kidney transplant recipients between 2009 and 2014 were included in this study. All individual-level cost data from specialized health care and data from all reimbursed medication and travel costs were acquired from official records. Cost data were compared before and after transplantation within the same patients starting from dialysis initiation and continued until the end of follow-up at the end of 2015. Results: Total annual costs were median 53 275 EUR per patient in dialysis, 59 583 EUR for the first post-transplantation year (P Conclusions: After the first posttransplant year the costs of a kidney transplant patient for the health care system arePeer reviewe

Effects of climate and historical adaptation measures on barley yield trends in Finland

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Short- and long-term survival after severe acute pancreatitis : A retrospective 17 years' cohort study from a single center

Purpose: To study mortality in severe acute pancreatitis (SAP) and to identify risk factors for mortality. Materials and methods: A retrospective 17-years' cohort study of 435 consecutive adult patientswith SAP treated at intensive care unit of a university hospital. Results: Overall, 357 (82.1%) patients survived at 90 days follow-up. Three-hundred six (89.5%) patients under 60 years, 38 (60.3%) patients between 60 and 69 years, and 13 (43.3%) patients over 69 years of age survived at 90 days follow-up. Independent risk factors for death within 90-days were: 60 to 69 years of age (odds ratio [OR] 5.1), >69 years of age (OR 10.4), female sex (OR 2.0), heart disease (OR 2.9), chronic liver failure (OR 12.3), open abdomen treatment (OR 4.4) and sterile necrosectomy within 4 weeks (OR 14.7). The 10-year survival estimate was Conclusions: Although younger patients have excellent short-term survival after SAP, the long-term survival estimate is disappointing mostly due to alcohol abuse. (C) 2019 Elsevier Inc. All rights reserved.Peer reviewe

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE) : a multicentre, randomised, parallel, single-blinded trial

Background Decreased surgical site infections (SSIs) and morbidity have been reported with mechanical and oral antibiotic bowel preparation (MOABP) compared with no bowel preparation (NBP) in colonic surgery. Several societies have recommended routine use of MOABP in patients undergoing colon resection on the basis of these data. Our aim was to investigate this recommendation in a prospective randomised context. Methods In this multicentre, parallel, single-blinded trial, patients undergoing colon resection were randomly assigned (1: 1) to either MOABP or NBP in four hospitals in Finland, using a web-based randomisation technique. Randomly varying block sizes (four, six, and eight) were used for randomisation, and stratification was done according to centre. The recruiters, treating physicians, operating surgeons, data collectors, and analysts were masked to the allocated treatment. Key exclusion criteria were need for emergency surgery; bowel obstruction; colonoscopy planned during surgery; allergy to polyethylene glycol, neomycin, or metronidazole; and age younger than 18 years or older than 95 years. Study nurses opened numbered opaque envelopes containing the patient allocated group, and instructed the patients according to the allocation group to either prepare the bowel, or not prepare the bowel. Patients allocated to MOABP prepared their bowel by drinking 2 L of polyethylene glycol and 1 L of clear fluid before 6 pm on the day before surgery and took 2 g of neomycin orally at 7 pm and 2 g of metronidazole orally at 11 pm the day before surgery. The primary outcome was SSI within 30 days after surgery, analysed in the modified intention-to-treat population (all patients who were randomly allocated to and underwent elective colon resection with an anastomosis) along with safety analyses. The trial is registered with ClinicalTrials. gov, NCT02652637, and EudraCT, 2015-004559-38, and is closed to new participants. Findings Between March 17, 2016, and Aug 20, 2018, 738 patients were assessed for eligibility. Of the 417 patients who were randomised (209 to MOABP and 208 to NBP), 13 in the MOABP group and eight in the NBP were excluded before undergoing colonic resection; therefore, the modified intention-to-treat analysis included 396 patients (196 for MOABP and 200 for NBP). SSI was detected in 13 (7%) of 196 patients randomised to MOABP, and in 21 (11%) of 200 patients randomised to NBP (odds ratio 1 . 65, 95% CI 0 . 80-3 . 40; p= 0 . 17). Anastomotic dehiscence was reported in 7 (4%) of 196 patients in the MOABP group and in 8 (4%) of 200 in the NBP group, and reoperations were necessary in 16 (8%) of 196 compared with 13 (7%) of 200 patients. Two patients died in the NBP group and none in the MOABP group within 30 days. Interpretation MOABP does not reduce SSIs or the overall morbidity of colon surgery compared with NBP. We therefore propose that the current recommendations of using MOABP for colectomies to reduce SSIs or morbidity should be reconsidered. Copyright (c) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Farm level dynamic economic modelling of crop rotation with adaptation practices

Agriculture is facing increasing challenges under volatile commodity markets, on-going climate change with more frequent extreme weather events and tightened environmental constraints. Crop rotation is considered essential and may even gain more importance for sustainable farming in the context of climate change challenges while monocropping is expected to become increasingly problematic. This is, among others, because of increasing plant protection challenges due to warmer climate which is expected to result in severe droughts, heavy rainfall and waterlogging in northern latitudes more frequently. Such changes require improved soil structure and water retention, also aided by crop rotations, to avoid yield losses. Our objective is to build and apply a dynamic optimization model of farm level crop rotation on many field parcels over 30-40 years. The model takes into account various adaptation management methods such as fungicide treatment, soil improvements such as liming, and nitrogen fertilization, simultaneously with dynamic crop rotation choices. However, these management options come along with costs. Using the model, outcomes of crop growth simulation modeling can be included into economic analysis. Simulated new cultivars, suited for a longer growing season, can be defined as alternatives to current cultivars, both having specific nutrient and other input requirements such as water, labor or pesticides. The model is used in evaluating the value of future cultivars and other management practices in climate and socio-economic scenarios. The first results show that expected market prices have major impacts on the management choices, the resulting yield levels, production and income over time

More strategic farm management needed to adapt to climate change in the North Savo region

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The introduction of legume-based crop rotations: an impact assessment on cereal cropping farms in Finland

Grain legume production offers multiple environmental benefits and can enhance the sustainability of farming, but the legume area has been small and declining over the last decades in most European countries. Recently, grain legumes have gained importance because of the increases in prices of feed and food proteins, fertilizers and fuel, in addition to sustainability concerns. This study investigated the impacts of introducing grain legumes [faba beans (Vicia faba L.)] in cereal-dominated crop production systems typical for southwestern Finland. To investigate the economic effects as well as the effect grain legumes have on production and land use a dynamic optimization model was used. The results suggest significant crop yield gains if farmers consistently utilize the pre-crop value of legumes and other crops in crop rotations over several years. The farm economic gains of diversified legume rotations were found to be positive but relatively small assuming past prices, but they can be significantly higher if legume and nitrogen fertilizer prices increase in the future. Overall, faba bean-based rotations have positive long-term implications on soil quality and biodiversity and thus future viability and societal reputation of farming

Specific problems and solutions in climate change adaptation in North Savo region

Crop production for feed dominates land use in North Savo in eastern Finland. The value of dairy and beef production is appr. 70 % of the total value of agricultural production of the region. In climate change adaptation research we are especially interested in dairy and meat sectors, which are directly dependent on the development of productivity of crop production. Climate change implies changes in cereals and forage crop yields and nutritive quality. There are most likely increasing problems and risks related to overwintering and growing periods. Grass silage is mainly self-produced on farms and most often there is no market for silage. Silage production and use are vulnerable to changes in local climate, because lost yield cannot be easily replaced from market. Risks and costs due to increasing inter-annual yield volatility can be reduced by good management practices, such as crop rotation, plant protection, soil improvements and better crop protection against plant diseases.However the profitability of such measures is dependent on market and policy conditions. Nevertheless new cultivars and species, as well as various options for production and risk management, are most likely needed in future climate. Some adaptations may have multiple benefits which however may realize only in medium or long run. It is important to safeguard the most important and obviously needed adaptations, and identify market and socio-economic conditions which inhibit farmers from necessary adaptations and lead to reduced productivity and increased production costs