Pancreatic fibrosis, acinar atrophy and chronic inflammation in surgical specimens associated with survival in patients with resectable pancreatic ductal adenocarcinoma

Background Pancreatic ductal adenocarcinoma (PDAC), one of the most lethal malignancies, is increasing in incidence. However, the stromal reaction pathophysiology and its role in PDAC development remain unknown. We, therefore, investigated the potential role of histological chronic pancreatitis findings and chronic inflammation on surgical PDAC specimens and disease-specific survival (DSS). Methods Between 2000 and 2016, we retrospectively enrolled 236 PDAC patients treated with curative-intent pancreatic surgery at Helsinki University Hospital. All pancreatic transection margin slides were re-reviewed and histological findings were evaluated applying international guidelines. Results DSS among patients with no fibrosis, acinar atrophy or chronic inflammation identified on pathology slides was significantly better than DSS among patients with fibrosis, acinar atrophy and chronic inflammation [median survival: 41.8 months, 95% confidence interval (CI) 26.0-57.6 vs. 20.6 months, 95% CI 10.3-30.9; log-rank test p = 0.001]. Multivariate analysis revealed that Ca 19-9 > 37 kU/l [hazard ratio (HR) 1.48, 95% CI 1.02-2.16], lymph node metastases N1-2 (HR 1.71, 95% CI 1.16-2.52), tumor size > 30 mm (HR 1.47, 95% CI 1.04-2.08), the combined effect of fibrosis and acinar atrophy (HR 1.91, 95% CI 1.27-2.88) and the combined effect of fibrosis, acinar atrophy and chronic inflammation (HR 1.63, 95% CI 1.03-2.58) independently served as unfavorable prognostic factors for DSS. However, we observed no significant associations between tumor size (> 30 mm) and the degree of perilobular fibrosis (p = 0.655), intralobular fibrosis (p = 0.587), acinar atrophy (p = 0.584) or chronic inflammation (p = 0.453). Conclusions Our results indicate that the pancreatic stroma is associated with PDAC patients' DSS. Additionally, the more severe the fibrosis, acinar atrophy and chronic inflammation, the worse the impact on DSS, thereby warranting further studies investigating stroma-targeted therapies.Peer reviewe

Hiki, ähky ja loikka - Osallistujien pedagogisia mietteitä ja ideoita hankkeen varrelta

DIGIJOUJOU-hankkeessa työskennelleet opettajat ovat hankkeen toimintavuosien 2017-2019 aikana pohtineet opetuksen ja oppimisen digitaalisuutta ja joustavuutta eri näkökulmista: mitä digitaalisuus ja joustavuus suomen ja ruotsin opiskelussa tarkoittaa, miten soveltaa, lisätä ja kehittää digitaalisuutta ja joustavuutta omassa opetuksessa ja opiskelijoiden oppimisessa. Hankelaisten blogikirjoituksissa näemme askeleita opettajien omasta ja yhdessä muiden kanssa oppimisesta hankkeen edetessä; epävarmuus muuttuu varmuudeksi, ajoittainen digiähky oman asiantuntijuuden kasvuksi ja joustavuus osaksi opettajan arkipedagogiikkaa. Antoisia ja inspiroivia lukuhetkiä! Lisätietoa: https://digijoujou.aalto.fi/Lärarna i DIGIJOUJOU-projektet har under projektets verksamhetsår 2017-2019 reflekterat över digitalisering och exibilitet från olika perspektiv; vad betyder digitalisering och exibilitet i lärandet av finska och svenska, hur ska man implementera, öka och utveckla dessa i den egna undervisningen och i hur studerande lär sig finska och svenska. I projektdeltagarnas bloginlägg får vi inblick i hur allas lärandeprocess i projektet framskrider; osäkerhet utvecklas till säkerhet, digikaoset får ordning och exibilitet blir en del av den egna sakkunnigheten och pedagogiken. Med önskan om givande och inspirerande läsning! Mer information: https://digijoujou.aalto.fi

Edistyneen suomenoppijan digitaaliset oppimateriaalit – nykytilanne ja uusia suuntia

Kielenoppijoiden elämänpiiri muuttuu teknistymisen myötä. Omaa mobiililaitettaan mukanaan kuljettava oppija voisi ideaalitilanteessa käyttää tekniikkaa monipuolisesti niin ympäristönsä kielenkäyttötilanteiden etukäteisharjoitteluun kuin tilanteiden tarjoumien havaitsemiseen ja hyödyntämiseen. Pullonkaulana on usein kuitenkin materiaalien tai sovellusten löytäminen. Kielibuusti-hankkeessa tekemämme kartoituksen mukaan erilaisia valmiita materiaaleja ja sovelluksia on olemassa, mutta sopivan, ajantasaisen ja oppijaa hyödyttävän materiaalin paikantaminen ja valitseminen erityisesti alkeistason jo ohittaneille oppijoille on haastavaa. Tässä on edelleen suuri rooli materiaalit tuntevalla opettajalla.nonPeerReviewe

Migrants at the university doorstep : How we unfairly deny access and what we could (should) do now

The Finnish Government recently launched policies to meet labor shortage challenges, recruit highly skilled international workers. However, they overlook a skilled population already living in Finland, namely highly educated migrants. The problem is that migrants tend to be treated similarly, whether they are well-educated or not. This means that migrants are typically directed into low paying jobs. How is it possible to better develop this group with more effective career guidance? We believe an important answer lies in improved university education for migrants. This investigation is based on responses from surveys, interviews, and project evaluations. An analysis is made of three successful university-based short-term integration programs. The emerging questions include, to what extent are obstacles for migrants appropriately deliberated in universities? What can we learn from the three model programs? Should language learning be incorporated into advanced academic programs? The analysis includes how current practices constrain migrants’ access to university education. Even with positive intentions, the prevailing understanding of equality involves equal treatment for all, despite educational or other differences. In addition, simplistic understanding of language skills and learning appears to predominate how migrants are treated. Highly educated migrants face serious challenges when there is a disconnect between language training and one’s disciplinary studies. We surmise there are critical differences between general population language training programs and those situated within disciplinary departments. Analysis of the model programs reveals that a systematic and holistic approach for overcoming current challenges is possible but with an emphasis on sustainability.peerReviewe

Chronic use of statins and aminosalicylic acid and incidence of post-ERCP acute pancreatitis. Preliminary data from the STARK study, a prospective international, multicenter, cohort study

No abstract availabl

Chronic use of statins and acetylsalicylic acid and incidence of post‐endoscopic retrograde cholangiopancreatography acute pancreatitis: A multicenter, prospective, cohort study

Objectives Post‐endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis (PEP) is a frequent complication of this endoscopic procedure. Chronic statin intake has been linked to lower incidence and severity of acute pancreatitis (AP). Periprocedural rectal administration of non‐steroidal anti‐inflammatory drugs is protective against PEP, but the role of chronic acetylsalicylic acid (ASA) treatment is unclear. We aimed to investigate whether statins and chronic ASA intake are associated with lower risk of PEP. Methods An international, multicenter, prospective cohort study. Consecutive patients undergoing ERCP in seven European centers were included. Patients were followed‐up to detect those with PEP. Multivariate analysis by means of binary logistic regression was performed, and adjusted odds ratios (aORs) were calculated. Results A total of 1150 patients were included, and 70 (6.1%) patients developed PEP. Among statins users, 8.1% developed PEP vs. 5.4% among non‐users (P = 0.09). Multivariate analysis showed no association between statin use and PEP incidence (aOR 1.68 (95% CI 0.94–2.99, P = 0.08)). Statin use had no effect on severity of PEP, being mild in 92.0% of statin users vs. 82.2% in non‐statin users (P = 0.31). Chronic ASA use was not associated with PEP either (aOR 1.02 (95% CI 0.49–2.13), P = 0.96). Abuse of alcohol and previous endoscopic biliary sphincterotomy were protective factors against PEP, while >1 pancreatic guidewire passage, normal bilirubin values, and duration of the procedure >20 minutes, were risk factors. Conclusions The use of statins or ASA is not associated with a lower risk or a milder course of PE

Machine learning for the prediction of post-ERCP pancreatitis risk: A proof-of-concept study

Background: Predicting Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) risk can be determinant in reducing its incidence and managing patients appropriately, however studies conducted thus far have identified single-risk factors with standard statistical approaches and limited accuracy. Aim: To build and evaluate performances of machine learning (ML) models to predict PEP probability and identify relevant features. Methods: A proof-of-concept study was performed on ML application on an international, multicenter, prospective cohort of ERCP patients. Data were split in training and test set, models used were gradient boosting (GB) and logistic regression (LR). A 10-split random cross-validation (CV) was applied on the training set to optimize parameters to obtain the best mean Area Under Curve (AUC). The model was re-trained on the whole training set with the best parameters and applied on test set. Shapley-Additive-exPlanation (SHAP) approach was applied to break down the model and clarify features impact. Results: One thousand one hundred and fifty patients were included, 6.1% developed PEP. GB model outperformed LR with AUC in CV of 0.7 vs 0.585 (p-value=0.012). GB AUC in test was 0.671. Most relevant features for PEP prediction were: bilirubin, age, body mass index, procedure time, previous sphincterotomy, alcohol units/day, cannulation attempts, gender, gallstones, use of Ringer's solution and periprocedural NSAIDs. Conclusion: In PEP prediction, GB significantly outperformed LR model and identified new clinical features relevant for the risk, most being pre-procedural