ASO Author Reflection : Demographic Conditions are the Major Determinants for Functional Outcome and Quality of Life in Lower Extremity Soft Tissue Sarcoma Patients

Non peer reviewe

Microvascular reconstruction in extremity soft tissue sarcoma surgery

Soft tissue sarcomas (STS) are rare tumors of soft tissue occurring most frequently in the extremities. Modern treatment of extremity STS is based on limb-sparing surgery combined with radiotherapy. To prevent local recurrence, a healthy tissue margin of 2.5 cm around the resected tumor is required. This results in large defects of soft tissue and bone, necessitating the use of reconstructive surgery to achieve wound closure. When local or pedicled soft tissue flaps are unavailable, reconstruction with free flaps is used. Free flaps are elevated at a distant site, and have their blood flow restored at the recipient site through microvascular anastomosis. When limb-sparing surgery is made impossible, amputation is the only option. Proximal amputation such as forequarter amputation (FQA) causes considerable morbidity, but is nevertheless warranted for carefully selected patients for cure or palliation. 116 patients treated in 1985 - 2006 were included in the study. Of these, 93 patients treated with limb-sparing surgery and microvascular reconstructive surgery after resection of extremity STS. 25 patients who underwent FQA were also included. Patients were identified and their medical records retrospectively reviewed. In all, 105 free flap procedures were performed for 103 patients. A total of 95 curatively treated STS patients were included in survival analysis. The latissimus dorsi, used in 56% of cases, was the most frequently used free flap. Free flap success rate was 96%. There were 9% microvascular anastomosis complications and 15% wound complications. For curatively treated STS patients, local recurrence-free survival at 5 years was 73.1%, metastasis-free survival 58.3%, and overall disease-specific survival 68.9%. Functional results were good, with 75% of patients regaining normal or near-normal function after lower extremity, and 55% after upper extremity STS resection. Among curatively treated forequarter amputees, 5-year disease-free survival was 44%. In the palliatively treated group median time until disease death was 14 months. Microvascular reconstruction after extremity soft tissue sarcoma resection is safe and reliable, and produces well-healing wounds allowing early oncological treatment. Oncological outcome after these procedures is comparable to that of other extremity sarcoma patients. Functional results are generally good. Forequarter amputation is a useful treatment option for soft tissue tumors of the shoulder girdle and proximal upper extremity. When free flap coverage of extended forequarter amputation is required, the preferable flap is a fillet flap from the amputated extremity. Acceptable oncological outcome is achieved for curatively treated FQA patients. In the palliatively treated patient considerable periods of increased quality of life can be achieved.Pehmytkudossarkoomat (PKS) ovat harvinaisia pahanlaatuisia kasvaimia (n 1% aikuisten kasvaimista) joista valtaosa ilmenee raajoissa. Raajan PKS:n nykyaikainen hoito perustuu raajan säästävään kirurgiaan ja sädehoitoon. Uusiutumisen ehkäisemiseksi tarvitaan 2.5 cm:n tervekudosmarginaali, ja laajat luu- ja pehmytkudospuutokset vaativat usein korjaavan kirurgian menetelmiä. Kun paikalliset tai varrelliset pehmytkudoskielekkeet eivät riitä, tulee kyseeseen vapaa mikrovaskulaarinen kieleke. Kielekkeen verenkierto palautetaan yhdistämällä sen verisuonet mikrokirurgista tekniikkaa käyttäen kohdealueen verisuoniin. Kun raajaa ei voida säästää, on amputaatio ainoa vaihtoehto. Proksimaaliset amputaatiot kuten forequarter-amputaatio (FQA) (yläraajan, lapaluun ja osittainen solisluun poisto) ovat tarkoin valittujen potilaiden kohdalla aiheellisia. Amputaation tavoite on joko syövän parantaminen (kuraatio) tai oireiden leivittäminen (palliaatio). Tutkimukseen sisällytettiin 116 vuosina 1985 – 2006 hoidettua potilasta. Raajan PKS hoidettiin 93:lla potilaalla raajan säästävällä kirurgialla ja mikrovaskulaarisella kielekekorjauksella. Myös 25 FQA:n läpikäynyttä potilasta sisällytettiin. Potilaiden sairaskertomustietoja tarkasteltiin retrospektiivisesti. Kaikkiaan tehtiin 105 mikrovaskulaarista kielekettä 103:lle potilaalle. Onkologisiin eloonjäämisanalyyseihin sisällytettiin 95 kuratiivisesti hoidettua PKS-potilasta. Yleisimmin käytetty kieleke oli latissimus dorsi-kieleke (56%). Kielekesiirroista onnistuivat 96%. Mikrovaskulaarisen verisuoniliitoksen komplikaatio esiintyi 9%:ssa ja haavan paranemisongelmaa 15%:ssa tapauksista. Viiden vuoden paikallisuusiutuma-vapaa ennuste oli 73.1%, metastaasivapaa ennuste 58.3% ja elossaoloennuste 68.9%. Jopa 75% alaraajan ja 55% yläraajan PKS:n vuoksi leikatuista potilaista saavutti seurannassa normaalin tai lähes normaalin raajan toiminnan. Kuratiivisen FQA:n läpikäyneiden potilaiden viiden vuoden elossaoloennuste oli 44%. Palliatiivisen amputaation jälkeen mediaanielossaoloaika oli 14 kuukautta. Mikrovaskulaarinen kielekerekonstruktio on turvallinen ja luotettava tapa korjata PKS-leikkauksen jälkeisiä kudospuutoksia. Mahdollisimman hyvät olosuhteet haavojen paranemiselle luodaan, eikä onkologisten hoitojen aloitus viivästy. Mikrovaskulaarisilla kielekkeillä hoidettujen potilaiden onkologinen ennuste ei eroa muiden PKS-potilaiden ennusteesta. Toimenpiteen jälkeen raajan toiminta säilyy hyvin. FQA on käyttökelpoinen menetelmä hartian seudun kasvainten hoidossa. Laajennetun FQA:n jälkeisen kudospuutoksen korjauksessa suositeltavin mikrovaskulaarikieleke on amputoidusta raajasta otettu ”fillet-flap”-kieleke. Kuratiivisesti hoidettujen potilaiden ennuste on hyväksyttävä, ja palliatiivisesti hoidettujen potilaiden oireita voidaan lievittää tehokkaasti

Innan den egentliga filmen börjar : Titelscenens funktion och struktur i långfilmen

Examensarbetets tema är titelscenen i långfilmen. Syftet med arbetet är att kartlägga titelscenens ursprung och utveckling samt att undersöka titelscenens funktion som en del av presentation eller exposition i långfilmen. Min forskning består av analyser av titelscenerna i olika fiktionsfilmer och undersöka hur titeln förhåller sig till resten av filmens berättande, stil och stämning. Filmerna som ingår i analyserna är Stranger than Fiction, I, Robot, Sleepy Hollow och Back to the Future. Som teoretisk bakgrund har jag undersökt inom följande filmteoretiska delområden: genre, dramaturgi, narratologi, typografi, semiotik. Efter varje analys gör jag en kort slutsats om titelscenens förhållande till filmen i fråga och diskuterar alternativa lösningar. Jag analyserar även filmer som saknar titelscener som jämförelse och diskuterar produktionsbolags logoanimationers roll i titelscenen. Titelscenens ursprung och utveckling framgår genom en historisk forskning. Min slutsats är att om titelscenen inte ger ett mervärde till filmen, är den endast i vägen för berättandet.The theme for my thesis is the title scene in feature films. My aim is to identify the origin and development of the title scene and to examine its function as part of the presentation or exposure of the movie. My research method is to analyze the title scenes in various fiction films and to examine how it relates to the rest of the film's narrative, style and mood. The films included in the analysis are Stranger than Fiction, I, Robot, Sleepy Hollow and Back to the Future. As a theoretical background, I study the following areas in film theory: Genre, Dramaturgy, Narratology, Typography, Semiotics. After each analysis, I make brief conclusions on how the title scene relates to the film in question and discuss alternative solutions. I also analyse films without title scenes for comparison and discuss the role of production company logo-animations in the title scene. Title origin and development of the title scene is examined through a historical research. My conclusion is that if the title scene does not add value to the film, it is only getting in the way of the storytelling

Ampumavammat

English summar

Risk factors, epidemiology and prognosis of cholangiocarcinoma in Finland

Background: Cholangiocarcinoma (CCA) is a cancer arising from the intra- and extrahepatic bile ducts. The early stages are often asymptomatic, CCA is frequently diagnosed in an advanced stage and the prognosis of CCA is often dismal. Objective: Our objective was to estimate the incidence of CCA in Finland and to identify risk factors for CCA, with a special interest in primary sclerosing cholangitis (PSC). Methods: We identified all CCA cases during 1974-2018 from the Finnish Cancer Registry and calculated age-standardised incidence rates. Five controls for each case were extracted from the Population Registry, matched by age, gender and municipality of residence at the time of diagnosis. Odds ratios (ORs) for risk factors were estimated with conditional logistic regression and survival estimates with the Kaplan-Meier method. Results: Incidence of CCA remained stable in both genders; the age-standardised rate (World Standard) in 2013-2017 in males and females was 1.7 per 100,000 person years and 1.3 per 100,000 person years, respectively. Primary sclerosing cholangitis carried a 30-fold risk of intrahepatic cholangiocarcinoma (iCCA) and 25-fold risk of extrahepatic cholangiocarcinoma (eCCA). Diabetes, inflammatory bowel disease and liver cirrhosis were associated with iCCA, whereas cholelithiasis and viral hepatitis C were associated with eCCA. The cumulative 5-year survival was 4.6%. Conclusions: The incidence of CCA has been stable. Known risk factors for CCA were confirmed, with PSC having the highest OR. Survival remains poor.Peer reviewe

Hablas vielleicht un peu la mia language? A comprehensive overview of the role of language differences in headquarters-subsidiary communication

The management of human resources in headquarters (HQ)-subsidiary relationships requires intensive communication, but effective communication often depends on having a shared language. Hence, language differences can be a serious threat to the successful management of human resources in multinational corporations (MNCs). In this large-scale quantitative study, encompassing data from more than 800 subsidiaries in thirteen countries, we investigated four related issues. First, in terms of the importance of language differences, we found that HQ-subsidiary relationships are clearly affected by language differences and that the latter form a distance category of their own, which should not be subsumed under the related, but separate concept of cultural differences. Second, regarding the consequences of language differences for communication outcomes, we found that a lack of a shared language is associated with misunderstanding, conflict and parallel information networks which could harm HQ-subsidiary interactions. Third, with regard to the impact of language differences on communication methods, we found that alack of a shared language is associated witha significantly lower level of oral (face-to-face and phone) communication, but not written communication. Fourth, and finally, in terms of a potential solution to communication problems caused by language differences, we found that expatriates can facilitate both communication and knowledge transfer between HQ and subsidiaries