text:
» Fishing
» PIKE IN OPEONGO???
6/22/2017 10:53 am #1
boknows
From: Ottawa, Ontario
PIKE IN OPEONGO???
i remember this topic being discussed in the old forum. Concern was pike could get into Opeongo via the Opeongo River from Booth Lake (even though there is a dam), or perhaps ice fishing with pike minnows, etc. (which is illegal).
Has anyone ever caught a pike in Opeongo?
CAMPING IS WHEN YOU SPEND A LOT OF MONEY TO LIVE LIKE A HOMELESS PERSON!
Jdbonney
Re: PIKE IN OPEONGO???
This has been a concern for over a decade. I haven't heard of anyone catching a pike but they are right below the dam in Annie's bay which is why it's a sanctuary there.
6/23/2017 12:05 pm #3
Yes. I knew about the dam at Annie's Bay and the pike and sanctuary there. Thankfully, they are still there and not in Opeongo.
6/23/2017 3:13 pm #4
The only way they could get into ope is through human intervention. Hopefully that doesn't happen.
From: Huntsville
Unfortunately it's a matter of time until some dumbass decides to catch a few at the bottom of the dam, then release them at the top (for god only knows what reason or rationale). Sadly, it wouldn't be the first time it happened either.
TOURduPARK.com
There was talk around the shop a few years ago that some made it into Opeongo the year the dam gave way but the "Official " word from the Park is no pike in Opeongo.
I beleove there were phone calls made to a few groups camped in the Eadt Arm that year asking if they had caught any.
The Columbia River is host to a Northern Pikeminnow derby (bounty), wherein fishermen/women are paid for every fish they deliver to a designated station. This is done to ease the pressure on salmon fry in that river. It would be interesting to see something similar in Booth, etc. Is it presumed that if pike were eliminated from that system (down to Shall), then those lakes would remain pike-less? Or did they originally come up from Victoria on their own?
In any case, increasing the pressure on pike in those lakes would only help the cause. I guess it might be weird to target a sport fish so intensely (vs the pikeminnow which I don't think is classified as a sport fish), but it sounds like the repercussions of them getting into Opeongo would be severe. And fishermen/women can have quite an effect on populations!
6/24/2017 3:14 am #8
Yes, Pike in Opeongo would DEFINITELY have an impact on the lake trout population.
Yes pray that it does not happen! I do like you pike bounty, but in Ontario and in Algonquin Park, a bounty on a game fish is not going to happen. Even though I hate catching pike, many love catching them......and that is the conundrum when it comes to pike in Opeongo.
Last edited by boknows (6/24/2017 3:18 am)
DanPM
From: Toronto
I like catching pike, and look forward to trying to on Crotch Lake later this summer, but I'd gladly give that up for the sake of the natural species communities in these lakes being restored.
That's never going to happen though, at least not through angling. The best we can do is try to depress their densities a little bit to reduce the chances of them spreading further.
By the way, while I've heard nothing to suggest that pike have made it into Opeongo, this research paper from 2011 suggests that pike have made it into Bridle (from Farm) and Galeairy (from Rapid). Also that walleye have gotten into Rock Lake (from Galeairy), largemouth bass are now in the Opeongo River system up to Farm and the Madawaska River system up to Whitefish, and rock bass are as widespread as pike in the Opeongo River system.
6/26/2017 10:11 am #10
PaPaddler
Fish species can also be spread by eggs that adhere to the feet/legs of wading birds such as Herons and are accidentally deposited in a new water body. Not sure of Pike nesting habits and whether they nest in shallows where herons feed...but this is a "natural" way of an invasive species being introduced to new areas.
frozentripper
Maybe it's worth mentioning that northern pike and lake trout can coexist in many northern lakes and both species will produce well enough to provide catch for anglers... Opeongo's lake trout may or may not decline, difficult to predict. Still, not a good thing to have non-residents or exotics moving in.
Damage to brook trout, the few still remaining in Opeongo and wherever else in the watershed, is more likely... BT don't compete well with or survive predators like pike along with other introductions, SM bass for example.
Last edited by frozentripper (6/26/2017 11:10 am)
6/26/2017 6:50 pm #12
Ecologically speaking, every lake is an island. Yes, northern pike and lake trout coexist in many lakes, but every lake offers a different set of conditions. Even within those physical parameters, fish populations in each lake are adapted to coexistence with the other species that are native to that lake. Little quirks like the exact timing of the spawn explain why (for example) muskie coexist with pike in some waters, exclude pike in others, and are excluded by pike in still others. The introduction of a new species to a lake can devastate the locally native species even if the same species coexist in other lakes, or it might not... brook trout have done much better coexisting with introduced smallies in Ragged Lake, for example, than in other APP lakes with introduced bass.
For what it's worth, the Fishing in Algonquin Provincial Park booklet predicts the following impacts if pike make it into Opeongo (my paraphrasing):
- Pike will transmit a harmful parasite to whitefish
- Lake trout will be forced away from the shallow littoral areas that they use for feeding during cold seasons, which will stunt their growth
- The few brook trout left in Opeongo will become even more insignificant in number and impossible to restore
- Pike are better at getting through shallow water barriers than bass, so from Opeongo they could get into unspoiled trout lakes in the watershed that don't have bass yet
- Smallmouth bass would be heavily impacted through competition and predation (though of course they're introduced as well so take your pick)
PaPaddler, thanks for pointing out the bird feet pathway. Park literature and management seems to focus on anglers being the way fish like pike get transferred over dams, hence the fishing prohibitions around dams and stuff... but to be honest I have some trouble believing that people would actually catch a pike, carry it up a portage trail around a dam, and release it on the other side... AND it survives this whole ordeal... AND this happens enough times within a pike's lifetime to establish a breeding population on the other side. But maybe folks have seen it happen? I've wondered if eagles and ospreys dropping their catch could be a factor.
Another factor complicating Opeongo's response is the introduction of lake herring or cisco in 1948, which was intended to boost lake trout production and harvest. And it seems that that introduction was successful, although spawning may have been delayed to older fish. Lake herring can be pelagic meaning that trout can find and feed on them in open water far from shore, where pike won't be, so there will be some separation.
Apparently the smallmouth bass introduction in 1928 did not affect lake trout harvest, maybe again because there wasn't much ecological overlap. Anyway, the situation is complicated and making predictions is risky. But the fact that many Ontario lakes do have coexisting northern pike and lake trout populations and it doesn't make much difference in harvest if one is present with the other, seems to suggest that, like the LH and SMB introductions of the past, it might not be a total disaster. Then, OTOH, it could be, which does add more interest to the picture, maybe something like watching a train wreck in slow motion. Sheesh, exotics, when are the asian carp coming...
6/27/2017 7:20 am #14
Just a little bit on exotics invasions... the usual story being given on how this happens is roads and minnow buckets being emptied where they shouldn't be. APP has hundreds of roads passing near formerly remote lakes and there will always be those characters driving and tossing minnows around with possibly some non-minnow species being included in the bucket. Illegal of course, but the opportunity to fish with minnows because they can and get away with it, too good to resist.
Outside the park, cottagers at times have an attitude... "well, this is my property, this is my lake, and I'll do whatever I please with it"... without much awareness of natural values and how things are and should be in their natural state. Carp, pike, bass - incoming, whatever's the favorite to fish for that day. Illegal again, and good luck to enforcement staff trying to keep track of thousands of cottagers doing whatever it is they want to do with their lake.
Last edited by frozentripper (6/27/2017 7:21 am)
I'd agree that smallmouth bass introductions didn't impact lake trout much, mostly brook trout, and the same would be true of pike just with a somewhat heavier impact on both species. There's a case to be made that of all the lakes that could get infected with pike, Opeongo isn't the worst, since much of the damage introduced predators can do has already been done by smallmouth bass. But the park booklet makes an interesting point about pike being better able to get upstream into new lakes than bass. Maybe the real worry should be pike getting from Crotch Lake over the falls and old dams into Shirley, which is still an unspoiled lake trout lake, and is connected by creek to Round Island and others.
And yes I'm aware of the "bait bucket pathway", I imagine it's a major source of perch invasion (which can be harmful to brook trout), but pike? Does anyone go fishing with a bucket full of baby pike?
Well, Algonquin lakes have remained free of pike for thousands of years, maybe as much as 10,000 years since glaciation, so my gut tells me that the "natural" pathways of pike invasion, by birds or over waterfalls in high water haven't been too effective in allowing them to extend their range over that long time period. The inflow of exotics seems to have occurred very recently, at the same time that roads were being built. My bet is on roads being an effective pathway for invasion, but who knows.
It's possible that there may be pike fry accidentally mixed in with minnows in the bucket, or the bucket fishermen may be releasing pike intentionally.... again who knows for sure, they're getting in one way or another, and roads and easy access probably have something to do with that.
To clarify, I certainly agree that human introduction (intentional or not) is what gets a fish like pike into an area or river system like the Opeongo. What I'm wondering about bird-related pathways is pike getting across barriers like dams within that river system. Maybe birds etc could carry pike or their eggs for such short distances only?


text:
'use strict';

var helper = require('../utils/helper.js');
describe('pet view page', function() {
	var page;

	beforeEach(function() {
		var mockModule = require('./pet.mocks');
		browser.addMockModule('httpBackendMock', mockModule );
		browser.get('/#/app/pet/view/1');
		page = require('./pet.view.po');
	});
	afterEach(function() {
		browser.clearMockModules();
	});

  it('should contain all fields.', function() {

    expect(page.birthDateEl).not.toBeNull()
    expect(page.nameEl).not.toBeNull()
    expect(page.typeEl).not.toBeNull()
    expect(page.ownerEl).not.toBeNull()
  });

  it('should contain searchable tables foreach includment of pet in other domain models', function() {

  });

  it('edit button changes path to /edit', function() {
	  element(by.id('editBtn')).click();
	  browser.wait(function() {
			  return $('#pet_form').isPresent(); // keeps waiting until this statement resolves to true
		  },
		  1000,
		  'pet_form element not visible'
	  );
	  helper.currentUrlContains('/#/app/pet/edit/1');

  });

  it('back button changes path to /list', function() {
	  element(by.id('backBtn')).click();
	  browser.wait(function() {
			  return $('#pet_list').isPresent(); // keeps waiting until this statement resolves to true
		  },
		  1000,
		  'pet_list element not visible'
	  );
	  helper.currentUrlContains('/#/app/pet/list');

  });

  it('delete button changes path to /list and deletes item', function() {
	  element(by.id('deleteBtn')).click();
	  browser.wait(function() {
			  return $('#pet_list').isPresent(); // keeps waiting until this statement resolves to true
		  },
		  1000,
		  'pet_list element not visible'
	  );
	  helper.currentUrlContains('/#/app/pet/list');

  });

});

redpajama_set_name: RedPajamaGithub


text:
A Miss Mexikó általánosan használt elnevezése, megszólítása a mexikói szépségversenyek győzteseinek. Az országban több ilyen versenyt is rendeznek, amik győztesei nemzetközi versenyeken képviselik hazájukat. A versenyek az alábbiak:

 Señorita Mexico: 1952 és 1993 között rendezett szépségverseny volt, aminek a győztese a Miss Universe, Miss World és Miss International versenyekre utazott. A legnagyobb eredmény egy Miss Universe-cím volt 1991-ben.
 Nuestra Belleza México: 1994-től napjainkig tartó rendezvénysorozat, a Senorita Mexico utódja. Szintén a fent említett nemzetközi versenyre küld résztvevőt. A legjobb eredmény 2 Miss International-cím volt (2007, 2009) és egy Miss Universe-cím (2010)
 Miss Earth Mexico: 2002-től napjainkig megtartott verseny, ami a Miss Earth szépségversenyre küld jelöltet. Legjobb eredménye egy 3. hely 2008-ban.

Señorita Mexico
A versenyt 1952-ben rendezték meg először. Ez a verseny volt hivatott mexikói jelöltet küldeni a Miss World, Miss Universe és Miss International versenyekre. A verseny történetében a legjelentősebb eredményt Lupita Jones érte el, akit 1991-ben Miss Universe-nek választottak. A győzelem után vita tört ki Jones és a rendezvény szervezői között, át nem adott díjak miatt. Ez a vita azt eredményezte, hogy a verseny szervezői és a versenyt közvetítő mexikó Televisa tévécsatorna szerződést bontott.

A verseny egy másik tévécsatornával, a TV Azteca-val kötött új szerződést, így a Televisa és Jones új versenyt hozott létre Nuestra Belleza Mexico néven. A következő évben a Senorita Mexico elvesztette azt a jogot, hogy versenyzőket küldjön a nemzetközi versenyekre, így a Nuestra Belleza lett a Miss Universe hivatalos mexikói versenye, majd később megszerezte a Miss World és a Miss International helyi szervezési jogait is. Ugyanakkor a Senorita Mexico továbbra is küld versenyzőket kisebb nemzetközi versenyekre, és 2005-ben a neve Miss Mexico-ra változott.

Győztesek
A lista a győztes neve mellett annak az államnak a nevét mutatja, amelyiket a versenyen képviselt. A táblázat utolsó oszlopa a Miss Universe versenyen elért eredményt mutatja.

Nuestra Belleza Mexico
A Nuestra Belleza Mexico (magyarul kb. "A mi mexikói szépségünk") egy évenkénti megrendezésű szépségverseny, amit először 1994-ben tartottak meg. A főszervezője Lupita Jones, aki mexikó első Miss Universe-győztese volt 1991-ben. A Televisa tévétársasággal együttműködve ez a verseny választja ki Mexikó képviselőit a Miss Universe, Miss World és Miss International versenyekre. A Nuestra Belleza Mexico eddigi legnagyobb eredménye két Miss International-cím 2007-ben és 2009-ben és egy Miss Universe-cím 2010-ben.

A versenyen részt venni szándékozó nőknek előbb az állami versenyeken kell részt venniük, ezek győztesei juthatnak be az országos döntőbe. Az állami versenyeken egészen addig vehet részt valaki újra és újra, míg megfelel az előírt korhatárnak, illetve amíg meg nem nyeri az adott állam versenyét. Ám az sem szokatlan, hogy egy állam egyidejűleg több versenyzőt is delegáljon az országos döntőbe. Mindez akkor történhet meg, ha a Nuestra Belleza Mexico szervezői kérik fel az adott plusz versenyzőt a részvételre, akár mert lehetőséget látnak benne, akár azért, mert nem minden állam indít döntőst egy adott évben, így ebben az esetben a létszámot kell betölteni. Körülbelül 30 vagy annál több versenyző jut a döntőbe évente.

A versenyzők a döntő előtt különféle eseményeken és szponzori rendezvényeken vesznek részt, ahol kiválasztják a döntőn belüli továbbjutókat (középdöntősöket), de akiknek a neve csupán a televízión is közvetített döntőn kerül a nyilvánosság elé. Néhányan különdíjakat kapnak, ami automatikusan bejuttatja őket a középdöntősök közé.

A középdöntősök fürdőruhában és estélyi ruhában mutatkoznak be, mindegyik után néhányan már nem jutnak tovább. A végül talpon maradt versenyzők interjú-kérdéseket kapnak, majd kihirdetik a helyezetteket és a győzteseket. Maga az egész verseny egy évvel korábban zajlik, mint az a nemzetközi verseny, amin a győztesek részt vesznek.

Két győztest hirdetnek, Nuestra Belleza Universo vesz részt a Miss Universe, Nuestra Belleza Mundo a Miss World versenyen.

Győztesek

Nuestra Belleza Universo
A lista a győztes neve mellett annak az államnak a nevét mutatja, amelyiket a versenyen képviselt. A táblázat utolsó oszlopa a Miss Universe versenyen elért eredményt mutatja. A Nuestra Belleza Universo címet elnyerő győztes mindig a következő évi Miss Universe versenyen vesz részt.

Nuestra Belleza Mundo
A lista a győztes neve mellett annak az államnak a nevét mutatja, amelyiket a versenyen képviselt. A táblázat utolsó oszlopa a Miss World versenyen elért eredményt mutatja. A legjobb eredmény egy 2. hely 2005-ben és 2009-ben.

Miss International-résztvevők

A lista a győztes neve mellett annak az államnak a nevét mutatja, amelyiket a versenyen képviselt. A táblázat utolsó oszlopa a Miss International versenyen elért eredményt mutatja.

Versenyek
2010

2010-ben a Mejor Traje Tipico különdíjért folyó versenyt Tiaré Crystal Oliva Elguelzabal nyerte. Ezen a vetélkedőn a versenyzők különféle mexikói nemzeti viselet jellegű ruhákat, jelmezeket mutatnak be. A különdíj győztese által viselt ruhát mutatja be a Nuestra Belleza Universo győztese a Miss Universe verseny Best National Costume (Legjobb Nemzeti Viselet) vetélkedőjén. A 2010. évi győztes jelmezt Fernando López tervezte.

 2011
A 2011-es versenyt augusztus 20-án rendezték meg. Három címet osztottak ki, győzteseik:
Nuestra Belleza México: Karina Gonzalez
Nuestra Belleza Mundo: Mariana Berumen
Nuestra Belleza Internacional: Nohemí Hermiosa lettek.
A második helyet Grecia Gutierrez, a harmadikat Lucia Silva nyerte el.

A különdíjak győztesei:
Miss Top Model: Miss Jalisco – Lucía Silva
Miss Congeniality: Miss Sinaloa – Grecia Gutiérrez
 Miss Talent: Miss Aguascalientes – Karina González
 Miss Sports: Miss Mexico City Distrito Federal – Mónica Gómez
 Academic Award: Miss Durango – Mónica Ayala
 Personality Fraiche: Miss Jalisco – Lucía Silva
 Steps to Fame: Miss Aguascalientes – Karina González
 Best National Costume: Miss Durango – Mónica Ayala "Diosa de Plata". Ezt a jelmezt a Miss Universe 2012 versenyen fogja viselni Karina Gonzalez.

Miss Earth Mexico

A Miss Earth Mexico verseny a 2001-ben indult Miss Earth nemzetközi szépségverseny mexikói döntője. Hivatalosan csak 2007-ben rendezték meg először, addig csupán felkértek versenyzőket a nemzetközi rendezvényen való részvételre. A legjobb eredmény egy 3. hely 2008-ban.

Győztesek
A lista a győztes neve mellett annak az államnak a nevét mutatja, amelyiket a versenyen képviselt. A táblázat utolsó oszlopa a Miss Earth versenyen elért eredményt mutatja.

 Perla Beltrán a 2007-ben rendezett versenyen második helyezést ért el, majd a 2008-as Nuestra Belleza Mexico versenyen megszerezte a Miss World-ön való indulási jogot, ahol 2. helyezést ért el 2009-ben.

Jegyzetek

Fordítás

Külső hivatkozások

 Képgaléria a 2010. évi versenyről

Mexiko
Mexikó kultúrája

redpajama_set_name: RedPajamaWikipedia


text:
AMERICAN HOCKEY LEAGUE ANNOUNCES 2019-20 WINNERS OF TEAM BUSINESS AWARDS
As part of the month-long 2020 AHL Team Business Spring Series, the American Hockey League today announced the winners of several awards recognizing the business successes of team staffs in the past year.
The 2020 AHL Team Business Spring Series, running May 19 through June 19, is a program of online presentations and discussions being hosted by the league's Team Business Services department. Team and league front-office personnel from throughout the American Hockey League meet each offseason to discuss best practices and innovative ideas in several areas, including ticket sales, corporate sales and marketing.
Allie Brown, senior director of marketing and creative services for the Iowa Wild, has been selected as the winner of the league's Ken McKenzie Award for the 2019-20 season. Recognizing the important role played by team management in building a successful franchise, the Ken McKenzie Award is presented annually to an AHL team executive who most successfully promotes his or her own club.
Brown, who joined the Wild in 2013 as an office administrator, now oversees the organization's digital marketing, traditional advertising, game operations, community relations, graphic design, video production and social media efforts, providing invaluable direction and contributing directly to many of the Wild's successful initiatives. Her leadership in game operations and video production has made the fan experience at Wells Fargo Arena one of the best in the AHL, and her progressive approach to promotions and sponsorships has allowed the Wild to show revenue growth for seven consecutive seasons.
The AHL's Ken McKenzie Award, first presented in 1978, honors Ken McKenzie, the founder and long-time publisher of The Hockey News and a 1997 media honoree by the Hockey Hall of Fame as the Elmer Ferguson Memorial Award winner. Mr. McKenzie was also the NHL's first publicity director and creator of its first media guide.
Other Team Business Awards announced today include:
The Springfield Thunderbirds won the ticket sales department of the year
The Cleveland Monsters won the corporate sales department of the year
The Syracuse Crunch won the social media department of the year
The San Diego Gulls won most unique ticket sales promotion or theme night for their "80's Night"
The Iowa Wild won most unique game operations promotion for their "Stranger Things Night"
The Manitoba Moose won most unique community relations initiative for their "Follow Your Dreams" game in conjunction with the Winnipeg Aboriginal Sport Achievement Centre
The Colorado Eagles won most unique social media promotion for their use of Tagboard
The Bakersfield Condors won most unique sponsorship package or entitlement for their Colonel's Caravan program
The Laval Rocket won outstanding marketing campaign for their "Ici l'Avenir/Witness the Future" program
In operation since 1936, the AHL serves as the top development league for all 31 National Hockey League teams. Nearly 90 percent of today's NHL players are American Hockey League graduates, and more than 100 honored members of the Hockey Hall of Fame spent time in the AHL in their careers.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Why does the length of calendar not equal 12 I'm new to python and was trying to create a list of month names. I noticed something odd:
len(calendar.month_name) == 12

False

Can anyone explain to me why the length of month names is not 12?
Thanky you for any advice!

A: Quoting the documentation:

This follows normal convention of January being month number 1, so it has a length of 13 and month_name[0] is the empty string.

A: The reason is because calendar.month_name[0] = '' this is probably to keep things simple for the rest of the months. So January is the first month or month number 1 and is also therefore calendar.month_name[1] and so on. This is probably just meant for simplicity. Since index 0 is empty and index 12 is December there are "13" months.

redpajama_set_name: RedPajamaStackExchange


text:
umu.sePublikasjoner
12 1 - 50 of 72
http://umu.diva-portal.org/smash/resultList.jsf?query=&language=no&searchType=SIMPLE&noOfRows=50&sortOrder=author_sort_asc&sortOrder2=title_sort_asc&onlyFullText=false&sf=all&aq=%5B%5B%7B%22personId%22%3A%22authority-person%3A63771%22%7D%5D%5D&aqe=%5B%5D&aq2=%5B%5B%5D%5D&af=%5B%5D
Boström, Petrus
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Haapamaki, Markku M.
Matthiessen, P.
Ljung, R.
Rutegård, Jörgen
Rutegård, Martin
High arterial ligation and risk of anastomotic leakage in anterior resection for rectal cancer in patients with increased cardiovascular risk2015Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 17, nr 11, s. 1018-1027Artikkel i tidsskrift (Fagfellevurdert)
Aim: Controversy still exists as to whether division of the inferior mesenteric artery close to the aorta influences the risk of anastomotic leakage after anterior resection for rectal cancer. This population-based study was carried out to evaluate the independent association between high arterial ligation and anastomotic leakage in patients with increased cardiovascular risk.
Method: All 2673 cases of registered anterior resection for rectal cancer from 2007 to 2010 were identified from the Swedish Colorectal Cancer Registry and cross-referenced with the Prescribed Drugs Registry, rendering a cohort of all patients with increased cardiovascular risk. Operative charts and registered data were reviewed for 722 patients. The association between high tie and anastomotic leakage, as quantified by ORs and 95% CIs, was evaluated in a logistic regression model, with adjustment for confounding, including assessment of interaction.
Results: Symptomatic anastomotic leakage occurred in 12.3% (41/334) of patients in the high tie group and in 10.6% (41/388) in the low tie group. The use of high tie was not independently associated with a higher risk of anastomotic leakage (OR = 1.05; 95% CI: 0.61–1.84). In a post-hoc analysis, patients with a history of manifest cardiovascular disease and American Society of Anesthesiologists (ASA) score III–IV seemed to be at greater risk (OR = 3.66; 95% CI: 1.04–12.85).
Conclusion: In the present population-based, observational setting, high tie was not independently associated with an increased risk of symptomatic anastomotic leakage after anterior resection for rectal cancer. However, this conclusion may not hold for patients with severe cardiovascular disease.
Haapamäki, Markku M
Matthiessen, Peter
Population‐based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer2019Inngår i: BJS Open, E-ISSN 2474-9842, Vol. 3, nr 1, s. 106-111Artikkel i tidsskrift (Fagfellevurdert)
Background: Anastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors.
Methods: This was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses.
Results: Of 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage.
Conclusion: Anastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.
Kverneng Hultberg, Daniel
Häggström, Jenny
Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
Haapamäki, Markku
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer: A Nationwide Cohort Study2019Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Artikkel i tidsskrift (Fagfellevurdert)
Objective: The purpose of this study was to investigate the impact of tie level on oncological outcomes in rectal cancer surgery.
Summary background data: Theoretically, a high tie of the inferior mesenteric artery could facilitate removal of apical node metastases and improve tumor staging accuracy. However, no appropriately sized randomized controlled trial exists and results from observational studies are not consistent.
Methods: All stage I–III rectal cancer patients who underwent abdominal surgery with curative intention in 2007 to 2014 were identified and followed, using the Swedish Colorectal Cancer Registry. Primary outcome was cancer-specific survival, whereas overall and relative survival, locoregional and distant recurrence, and lymph node harvest were secondary outcomes, with high tie as exposure. We used propensity score matching to emulate a randomized controlled trial, and then performed Cox regression analyses to estimate hazard ratios (HRs) with confidence intervals (CIs).
Results: Some 8287 patients remained for analysis, of which 37% had high tie surgery. After propensity score matching, the 5-year cancer-specific survival rate was overall 86% and we found no association between the level of tie and cancer-specific (HR 0.92, 95% CI 0.79–1.07) or overall (HR 0.98, 95% CI 0.89–1.08) survival, nor to locoregional (HR 0.85, 95% CI 0.59–1.23) or distant (HR 1.01, 95% CI 0.88–1.15) recurrence, nor to relative survival (HR 1.05, 95% CI 0.85–1.28). Stratification and sensitivity analyses were similarly insignificant, after adjustment for confounding. Total lymph node harvest was, however, increased after high tie surgery (P < 0.01), but no differences were seen regarding positive nodes (P = 0.72).
Conclusion: In this nationwide cohort study, the level of tie did not influence any patient-oriented oncological outcome, neither overall nor in node-positive patients. This would allow the patient's anatomical configuration and the surgeon's preferences to determine the level of tie.
Arterial ligation in anterior resection for rectal cancer: A validation study of the Swedish Colorectal Cancer Registry2014Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, nr 7, s. 892-7Artikkel i tidsskrift (Fagfellevurdert)
ABSTRACT Background. The level of arterial ligation has been a variable of the Swedish Colorectal Cancer Registry since 2007. The aim of this study is to evaluate the accuracy of this registry variable in relation to anterior resection for rectal cancer. Methods. The operative charts of all cardiovascularly compromised patients who underwent anterior resection during the period 2007-2010 in Sweden were retrieved and compared to the registry. We selected the study population to reflect the common assumption that these patients would be more sensitive to a compromised visceral blood flow. Levels of vascular ligation were defined, both oncologically and functionally, and their sensitivity, specificity, positive and negative predictive values, level of agreement and Cohen's kappa were calculated. Results. Some 744 (94.5%) patients were eligible for analysis. Functional high tie level showed a sensitivity of 80.2% and a specificity of 90.1%. Positive and negative predictive values were 87.7 and 83.8%, respectively. Level of agreement was 85.5% and Cohen's kappa 0.70. The corresponding calculations for oncologic tie level yielded similar results. Conclusion. The suboptimal validity of the Swedish Colorectal Cancer Registry regarding the level of vascular ligation might be problematic. For analyses with rare positive outcomes, such bowel ischaemia, or with minor expected differences in outcomes, it would be beneficial to collect data directly from the operative charts of the medical records in order to increase the chance of identifying clinically relevant differences.
Dahlin, Anna M
Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
Henriksson, Maria L
Van Guelpen, Bethany
Stenling, Roger
Öberg, Åke
Palmqvist, Richard
Colorectal cancer prognosis depends on T-cell infiltration and molecular characteristics of the tumor2011Inngår i: Modern Pathology, ISSN 0893-3952, E-ISSN 1530-0285, Vol. 24, s. 671-682Artikkel i tidsskrift (Fagfellevurdert)
The aim of this study was to relate the density of tumor infiltrating T cells to cancer-specific survival in colorectal cancer, taking into consideration the CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) screening status. The T-cell marker CD3 was stained by immunohistochemistry in 484 archival tumor tissue samples. T-cell density was semiquantitatively estimated and scored 1-4 in the tumor front and center (T cells in stroma), and intraepithelially (T cells infiltrating tumor cell nests). Total CD3 score was calculated as the sum of the three CD3 scores (range 3-12). MSI screening status was assessed by immunohistochemistry. CIMP status was determined by quantitative real-time PCR (MethyLight) using an eight-gene panel. We found that patients whose tumors were highly infiltrated by T cells (total CD3 score ≥7) had longer survival compared with patients with poorly infiltrated tumors (total CD3 score ≤4). This finding was statistically significant in multivariate analyses (multivariate hazard ratio, 0.57; 95% confidence interval, 0.31-1.00). Importantly, the finding was consistent in rectal cancer patients treated with preoperative radiotherapy. Although microsatellite unstable tumor patients are generally considered to have better prognosis, we found no difference in survival between microsatellite unstable and microsatellite stable (MSS) colorectal cancer patients with similar total CD3 scores. Patients with MSS tumors highly infiltrated by T cells had better prognosis compared with intermediately or poorly infiltrated microsatellite unstable tumors (log rank P=0.013). Regarding CIMP status, CIMP-low was associated with particularly poor prognosis in patients with poorly infiltrated tumors (multivariate hazard ratio for CIMP-low versus CIMP-negative, 3.07; 95% confidence interval, 1.53-6.15). However, some subset analyses suffered from low power and are in need of confirmation by independent studies. In conclusion, patients whose tumors are highly infiltrated by T cells have a beneficial prognosis, regardless of MSI, whereas the role of CIMP status in this context is less clear.
Jacobsson, Maria
Eklöf, Vincy
The role of the CpG island methylator phenotype in colorectal cancer prognosis depends on microsatellite instability screening status2010Inngår i: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 16, nr 6, s. 1845-1855Artikkel i tidsskrift (Fagfellevurdert)
PURPOSE: The aim of this study was to relate the CpG island methylator phenotype (CIMP; characterized by extensive promoter hypermethylation) to cancer-specific survival in colorectal cancer, taking into consideration relevant clinicopathologic factors, such as microsatellite instability (MSI) screening status and the BRAF V600E mutation.
EXPERIMENTAL DESIGN: Archival tumor samples from 190 patients from the Northern Sweden Health and Disease Study (NSHDS) and 414 patients from the Colorectal Cancer in Umeå Study (CRUMS), including 574 with cancer-specific survival data, were analyzed for an eight-gene CIMP panel using quantitative real-time PCR (MethyLight). MSI screening status was assessed by immunohistochemistry.
RESULTS: CIMP-low patients had a shorter cancer-specific survival compared with CIMP-negative patients (multivariate hazard ratio in NSHDS, 2.01; 95% confidence interval, 1.20-3.37; multivariate hazard ratio in CRUMS, 1.48; 95% confidence interval, 1.00-2.22). This result was similar in subgroups based on MSI screening status and was statistically significant in microsatellite stable (MSS) tumors in NSHDS. For CIMP-high patients, a shorter cancer-specific survival compared with CIMP-negative patients was observed in the MSS subgroup. Statistical significance was lost after adjusting for the BRAF mutation, but the main findings were generally unaffected.
CONCLUSIONS: In this study, we found a poor prognosis in CIMP-low patients regardless of MSI screening status, and in CIMP-high patients with MSS. Although not consistently statistically significant, these results were consistent in two separate patient groups and emphasize the potential importance of CIMP and MSI status in colorectal cancer research.
7. Djureinovic, Tatjana
Lindblom, Annika
Dalén, Johan
Dedorson, Stefan
Edler, David
Hjern, Fredrik
Holm, Jörn
Lenander, Claes
Lindforss, Ulrik
Lundqvist, Nils
Olivecrona, Hans
Olsson, Louise
Påhlman, Lars
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
Smedh, Kennet
Törnqvist, Anders
Eiberg, Hans
Bisgaard, Marie Luise
The CHEK2 1100delC variant in Swedish colorectal cancer.2006Inngår i: Anticancer Res, ISSN 0250-7005, Vol. 26, nr 6C, s. 4885-8Artikkel i tidsskrift (Fagfellevurdert)
Edin, Sofia
Wikberg, Maria L.
Dahlin, Anna M.
Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
Oldenborg, Per-Arne
Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Histologi med cellbiologi.
The Distribution of Macrophages with a M1 or M2 Phenotype in Relation to Prognosis and the Molecular Characteristics of Colorectal Cancer2012Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 10, s. e47045- Artikkel i tidsskrift (Fagfellevurdert)
High macrophage infiltration has been correlated to improved survival in colorectal cancer (CRC). Tumor associated macrophages (TAMs) play complex roles in tumorigenesis since they are believed to hold both tumor preventing (M1 macrophages) and tumor promoting (M2 macrophages) activities. Here we have applied an immunohistochemical approach to determine the degree of infiltrating macrophages with a M1 or M2 phenotype in clinical specimens of CRC in relation to prognosis, both in CRC in general but also in subgroups of CRC defined by microsatellite instability (MSI) screening status and the CpG island methylator phenotype (CIMP). A total of 485 consecutive CRC specimens were stained for nitric oxide synthase 2 (NOS2) (also denoted iNOS) as a marker for the M1 macrophage phenotype and the scavenger receptor CD163 as a marker for the M2 macrophage phenotype. The average infiltration of NOS2 and CD163 expressing macrophages along the invasive tumor front was semi-quantitatively evaluated using a four-graded scale. Two subtypes of macrophages, displaying M1 (NOS2(+)) or M2 (CD163(+)) phenotypes, were recognized. We observed a significant correlation between the amount of NOS2(+) and CD163(+) cells (P<0.0001). A strong inverse correlation to tumor stage was found for both NOS2 (P<0.0001) and CD163 (P<0.0001) infiltration. Furthermore, patients harbouring tumors highly infiltrated by NOS2+ cells had a significantly better prognosis than those infiltrated by few NOS2+ cells, and this was found to be independent of MSI screening status and CIMP status. No significant difference was found on cancer-specific survival in groups of CRC with different NOS2/CD163 ratios. In conclusion, an increased infiltration of macrophages with a M1 phenotype at the tumor front is accompanied by a concomitant increase in macrophages with a M2 phenotype, and in a stage dependent manner correlated to a better prognosis in patients with CRC.
Wikberg, Maria L
Phenotypic skewing of macrophages in vitro by secreted factors from colorectal cancer cells2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 9, s. e74982- Artikkel i tidsskrift (Fagfellevurdert)
Macrophages are cells with many important functions in both innate and adaptive immune responses and have been shown to play a complex role in tumor progression since they harbour both tumor preventing (M1 macrophages) and tumor promoting (M2 macrophages) activities. In many human cancers, infiltrating macrophages have been associated with a poor patient prognosis, and therefore suggested to be mainly of an M2 phenotype. However, we and others have previously shown that increased macrophage density in colorectal cancer (CRC) instead is correlated with an improved prognosis. It is an intriguing question if the different roles played by macrophages in various cancers could be explained by variations in the balance between M1 and M2 macrophage attributes, driven by tumor- or organ-specific factors in the tumor microenvironment of individual cancers. Here, we utilized an in vitro cell culture system of macrophage differentiation to compare differences and similarities in the phenotype (morphology, antigen-presentation, migration, endocytosis, and expression of cytokine and chemokine genes) between M1/M2 and tumor activated macrophages (TAMs), that could explain the positive role of macrophages in CRC. We found that secreted factors from CRC cells induced TAMs of a "mixed" M1/M2 phenotype, which in turn could contribute to a "good inflammatory response". This suggests that re-education of macrophages might allow for important therapeutic advances in the treatment of human cancer.
Lundgren, David
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
Karling, Pontus
Löfgren Burström, Anna
The combined diagnostic value of faecal haemoglobin and calprotectin in colorectal cancerManuskript (preprint) (Annet vitenskapelig)
Löfgren-Burström, Anna
Zingmark, Carl
Larsson, Pär
Alexeyev, Oleg
Cancer-associated fecal microbial markers in colorectal cancer detection2017Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 141, nr 12, s. 2528-2536Artikkel i tidsskrift (Fagfellevurdert)
Colorectal cancer (CRC) is the second most common cause of cancer death in the western world. An effective screening program leading to early detection of disease would severely reduce the mortality of CRC. Alterations in the gut microbiota have been linked to CRC, but the potential of microbial markers for use in CRC screening has been largely unstudied. We used a nested case-control study of 238 study subjects to explore the use of microbial markers for clbA+ bacteria harboring the pks pathogenicity island, afa-C+ diffusely adherent Escherichia coli harboring the afa-1 operon, and Fusobacterium nucleatum in stool as potential screening markers for CRC. We found that individual markers for clbA+ bacteria and F. nucleatum were more abundant in stool of patients with CRC, and could predict cancer with a relatively high specificity (81.5% and 76.9%, respectively) and with a sensitivity of 56.4% and 69.2%, respectively. In a combined test of clbA+ bacteria and F. nucleatum, CRC was detected with a specificity of 63.1% and a sensitivity of 84.6%. Our findings support a potential value of microbial factors in stool as putative noninvasive biomarkers for CRC detection. We propose that microbial markers may represent an important future screening strategy for CRC, selecting patients with a "high-risk" microbial pattern to other further diagnostic procedures such as colonoscopy.
Jonsson, Björn-Anders
Öberg, Å.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
The prognostic role of KRAS, BRAF, PIK3CA and PTEN in colorectal cancer2013Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 108, nr 10, s. 2153-2163Artikkel i tidsskrift (Fagfellevurdert)
Background Mutations in KRAS, BRAF, PIK3CA and PTEN expression have been in focus to predict the effect of epidermal growth factor receptor-blocking therapy in colorectal cancer (CRC). Here, information on these four aberrations was collected and combined to a Quadruple index and used to evaluate the prognostic role of these factors in CRC. Patients We analysed the mutation status in KRAS, BRAF and PIK3CA and PTEN expression in two separate CRC cohorts, Northern Sweden Health Disease Study (NSHDS; n = 197) and Colorectal Cancer in Umea Study (CRUMS; n = 414). A Quadruple index was created, where Quadruple index positivity specifies cases with any aberration in KRAS, BRAF, PIK3CA or PTEN expression. Results Quadruple index positive tumours had a worse prognosis, significant in the NSHDS but not in the CRUMS cohort (NSHDS; P = 0.003 and CRUMS; P = 0.230) in univariate analyses but significance was lost in multivariate analyses. When analysing each gene separately, only BRAF was of prognostic significance in the NSHDS cohort (multivariate HR 2.00, 95% CI: 1.16-3.43) and KRAS was of prognostic significance in the CRUMS cohort (multivariate HR 1.48, 95% CI: 1.02-2.16). Aberrations in PIK3CA and PTEN did not add significant prognostic information. Conclusions Our results suggest that establishment of molecular subgroups based on KRAS and BRAF mutation status is important and should be considered in future prognostic studies in CRC.
Floodeen, Hannah
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Hallböök, Olof
Department of Surgery, Linköping University Hospital, Linköping, Sweden.
Sjödahl, Rune
Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?2013Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 15, nr 3, s. 334-340Artikkel i tidsskrift (Fagfellevurdert)
Aim The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge. Method Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed. Results Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (P<0.001). Conclusion The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.
Gurmu, Ambatchew
Department of Surgical Gastroenterology, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Nyköping Hospital, Nyköping, Sweden and Department of Surgical Gastroenterology, K53, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden .
Nilsson, Sven
Department of Radiology, Akademiska University Hospital, Uppsala, Sweden.
Department of Surgery, Akademiska University Hospital, Uppsala, Sweden.
Gunnarsson, Ulf
Department of Surgical Gastroenterology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
The inter-observer reliability is very low at clinical examination of parastomal hernia2011Inngår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 26, nr 1, s. 89-95Artikkel i tidsskrift (Fagfellevurdert)
INTRODUCTION: Parastomal hernia in patients with a permanent colostomy is common. The aim of this study was to evaluate the reliability of the diagnosis based on clinical examination and to compare this examination with the result of a specially designed questionnaire and computerised tomography (CT) scan.
METHODS: Forty-one patients operated upon with an abdominoperineal resection due to rectal cancer at three hospitals between 1996 and 2002 were included. At minimum of 4 years after the operation, they underwent clinical examination by two or three independent surgeons, answered a colostomy questionnaire and were offered a CT scan of the abdominal wall.
RESULT: At Hospital I, 17 patients were examined by three surgeons, with inter-observer kappa values between 0.35 and 0.64. At Hospital II, 13 patients were examined by three surgeons, the kappa values ranged between 0.29 and 0.43. At Hospital III, 11 patients were examined by two surgeons, with kappa value of 0.73. The kappa value between CT scan and the colostomy questionnaire was 0.45.
CONCLUSION: The inter-observer reliability was low, indicating that parastomal hernia is difficult to diagnose by patient history and clinical examination. Some herniae may not be detected by CT scan, and the correlation to patient-reported complaints is low. A more sensitive radiological method to detect parastomal hernia is needed.
Pihlgren, Victoria
Lundberg, Owe
Sandzén, Birger
Physical performance and quality of life after extended abdominoperineal excision of rectum and reconstruction of the pelvic floor with gluteus maximus flap2011Inngår i: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, nr 1, s. 101-106Artikkel i tidsskrift (Fagfellevurdert)
The oncological outcome of the operation was acceptable, but functional drawbacks must be considered preoperatively in counseling the patient. More research is needed to find ways to preserve better function and well-being.
Colorectal Cancer Cells Activate Adjacent Fibroblasts Resulting in FGF1/FGFR3 Signaling and Increased Invasion.2011Inngår i: American Journal of Pathology, ISSN 0002-9440, E-ISSN 1525-2191, Vol. 178, nr 3, s. 1387-1394Artikkel i tidsskrift (Fagfellevurdert)
Cancer-associated fibroblasts expressing fibroblast activation protein (FAP) have been implicated in the invasive behavior of colorectal cancer. In this study, we use FAP expression as a marker of fibroblast activation and analyze the effect of activated fibroblasts on colorectal cancer migration and invasion in experimental cell studies. We also investigated the expression pattern of FAP in cancer-associated fibroblasts during transformation from benign to malignant colorectal tumors. In immunohistochemical analyses, FAP was expressed in fibroblasts in all colorectal cancer samples examined, whereas all normal colon, hyperplastic polyps, or adenoma samples were negative. In in vitro studies, conditioned medium from colon cancer cells, but not adenoma cells, activated fibroblasts by inducing FAP expression. These activated fibroblasts increased the migration and invasion of colon cancer cells in Boyden chamber experiments and in a three-dimensional cell culture model. We identify fibroblast growth factor 1/fibroblast growth factor receptor 3 (FGF1/FGFR-3) signaling as mediators leading to the increased migration and invasion. Activated fibroblasts increase their expression of FGF1, and by adding a fibroblast growth factor receptor inhibitor, as well as an FGF1-neutralizing antibody, we reduced the migration of colon cancer cells. Our findings provide evidence of a possible molecular mechanism involved in the cross talk between cancer cells and fibroblasts leading to cancer cell invasion.
17. Hertervig, Erik
Befrits, Ragnar
Ekbom, Anders
Karlén, Per
Lindberg, Jan
Löfberg, Robert
Sjöqvist, Urban
Ost, Ake
[Colitis cancer--myth or reality?]2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 45, s. 3000-3002Artikkel, forskningsoversikt (Fagfellevurdert)
Det finns specifika grupper av patienter med ulcerös kolit och crohnkolit som har ökad risk för att utveckla kolorektal cancer. Mycket tyder dock på att risken har reducerats under senare tid. Prognosen vid manifest kolorektal cancer har också förbättrats.
Inflammation i sig har visat sig vara en oberoende riskfaktor för kolorektal cancer. Den förbättrade antiinflammatoriska terapin med framför allt 5-aminosalicylsyra har visat sig vara en plausibel förklaring till den minskade risken.
Koloskopisk övervakning och förbättrad terapi vid manifest kolorektal cancer är faktorer som sannolikt ligger bakom en kraftigt förbättrad prognos.
Holmgren, Klas
Haapamäki, Markku M.
Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome2018Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, nr 12, s. 1631-1638Artikkel i tidsskrift (Fagfellevurdert)
Background: A permanent stoma after anterior resection for rectal cancer is common. Nationwide registries provide sufficient power to evaluate factors influencing this phenomenon, but validation is required to ensure the quality of registry-based stoma outcomes.
Methods: Patients who underwent anterior resection for rectal cancer in the Northern healthcare region of Sweden between 1 January 2007 and 31 December 2013 were reviewed by medical records and followed until 31 December 2014 with regard to stoma outcome. A registry-based method to determine nationwide long-term stoma outcomes, using data from the National Patient Registry and the Swedish Colorectal Cancer Registry, was developed and internally validated using the chart reviewed reference cohort. Accuracy was evaluated with positive and negative predictive values and Kappa values. Following validation, the stoma outcome in all patients treated with an anterior resection for rectal cancer in Sweden during the study period was estimated. Possible regional differences in determined stoma outcomes between the six Swedish healthcare regions were subsequently evaluated with the χ2 test.
Results: With 312 chart reviewed patients as reference, stoma outcome was accurately predicted through the registry-based method in 299 cases (95.8%), with a positive predictive value of 85.1% (95% CI 75.8%-91.8%), and a negative predictive value of 100.0% (95% CI 98.4%-100.0%), while the Kappa value was 0.89 (95% CI 0.82-0.95). In Sweden, 4768 patients underwent anterior resection during the study period, of which 942 (19.8%) were determined to have a permanent stoma. The stoma rate varied regionally between 17.8-29.2%, to a statistically significant degree (p = .001).
Conclusion: Using data from two national registries to determine long-term stoma outcome after anterior resection for rectal cancer proved to be reliable in comparison to chart review. Permanent stoma prevalence after such surgery remains at a significant level, while stoma outcomes vary substantially between different healthcare regions in Sweden.
Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Defunctioning stomas decrease chances of a stoma-free outcome after anterior resection for rectal cancerManuskript (preprint) (Annet vitenskapelig)
Jonsson, Pär
Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
Lundin, Christina
Sund, Malin
Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Preoperative biomarkers related to inflammation identify high-risk anastomoses in surgery for rectal cancer: an explorative study on patients with colorectal cancerManuskript (preprint) (Annet vitenskapelig)
High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study2017Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, nr 12, s. 1067-1075Artikkel i tidsskrift (Fagfellevurdert)
AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.
METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.
RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.
CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.
Matthiessen, P
Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study'2018Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 20, nr 4, s. 342-343Artikkel i tidsskrift (Fagfellevurdert)
Högberg, Cecilia
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
Lilja, Mikael
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency: A prospective study2017Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 1, s. 69-75Artikkel i tidsskrift (Fagfellevurdert)
OBJECTIVE: Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests.
MATERIALS AND METHODS: This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients' presenting symptoms were recorded. Patients were followed for 2 years.
RESULTS: The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22-0.67).
CONCLUSION: A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.
Diagnosis of colorectal cancer: Patients' symptoms and faecal immunochemical test results in primary care. A prospective studyManuskript (preprint) (Annet vitenskapelig)
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
Ljung, Thomas
Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer2013Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, nr 4, s. 209-214 Artikkel i tidsskrift (Fagfellevurdert)
Objective. To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care. Design. A retrospective population-based study. Setting and subjects. All 495 cases of CRC and adenomas with HGD diagnosed in the county of Jamtland, Sweden from 2005 to 2009. Results. Of 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005). Conclusion. IFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.
Isaksson-Mettävainio, Martin
High SMAD4 levels appear in MSI and hypermethylated colon cancers, and indicate a better prognosis2012Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 131, s. 779-788Artikkel i tidsskrift (Fagfellevurdert)
Colorectal cancer (CRC) is one of the most common causes of cancer related deaths in western countries. CRC are commonly divided in cancers showing microsatellite stability (MSS) or microsatellite instability (MSI). A more novel classification is dependent on promoter hypermethylation of CpG islands (the CpG island methylator phenotype, CIMP), where cancers show high, low or negative methylation status. SMAD4, located on chromosome 18q, has been thoroughly investigated during the last years. Loss of SMAD4 expression has been reported to correlate with poor CRC patient prognosis. In this study we analyze the impact of SMAD4 expression on prognosis in relation to MSI screening status and CIMP status. 479 paraffin-embedded specimens of CRC were examined for nuclear SMAD4 expression using immunohistochemistry. The tumors were scored loss (-), moderate (+) and high (++) expressing tumors. Loss of SMAD4 correlated significantly with decreased survival in all colon cancer patients. High SMAD4 expression, on the other hand, was significantly associated with increased survival, especially in colon cancer patients which has undergone potential curative surgery. In addition, in MSI tumors and CIMP-high tumors, high SMAD4 expression was significantly related to increase in survival, while loss of SMAD4 resulted in a significantly poorer prognosis. SMAD4 expression was not correlated to prognosis in rectal cancer cases. We conclude, loss of SMAD4 indicates a poor prognosis in colon cancer patients. The novel findings that high SMAD4 expression predicts a better prognosis suggests that SMAD4 immunohistochemistry could constitute a prognostic marker in combination with CIMP and MSI screening status.
27. Kong, So Yeon
Takeuchi, Masayoshi
Hyogo, Hideyuki
McKeown-Eyssen, Gail
Yamagishi, Sho-Ichi
Chayama, Kazuaki
O'Brien, Peter J.
Ferrari, Pietro
Overvad, Kim
Olsen, Anja
Tjonneland, Anne
Boutron-Ruault, Marie-Christine
Bastide, Nadia
Carbonnel, Franck
Kuehn, Tilman
Kaaks, Rudolf
Boeing, Heiner
Aleksandrova, Krasimira
Trichopoulou, Antonia
Lagiou, Pagona
Vasilopoulou, Effie
Masala, Giovanna
Pala, Valeria
De Magistris, Maria Santucci
Tumino, Rosario
Naccarati, Alessio
Bueno-De-Mesquita, H. B.
Peeters, Petra H.
Weiderpass, Elisabete
Quiros, J. Ramon
Jakszyn, Paula
Sanchez, Maria-Jose
Dorronsoro, Miren
Gavrila, Diana
Ardanaz, Eva
Nyström, Hanna
Wareham, Nicholas J.
Khaw, Kay-Tee
Bradbury, Kathryn E.
Romieu, Isabelle
Freisling, Heinz
Stavropoulou, Faidra
Gunter, Marc J.
Cross, Amanda J.
Riboli, Elio
Jenab, Mazda
Bruce, W. Robert
The Association between Glyceraldehyde-Derived Advanced Glycation End-Products and Colorectal Cancer Risk2015Inngår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 24, nr 12, s. 1855-1863Artikkel i tidsskrift (Fagfellevurdert)
Background: A large proportion of colorectal cancers are thought to be associated with unhealthy dietary and lifestyle exposures, particularly energy excess, obesity, hyperinsulinemia, and hyperglycemia. It has been suggested that these processes stimulate the production of toxic reactive carbonyls from sugars such as glyceraldehyde. Glyceraldehyde contributes to the production of a group of compounds known as glyceraldehyde-derived advanced glycation end-products (glycer-AGEs), which may promote colorectal cancer through their proinflammatory and pro-oxidative properties. The objective of this study nested within a prospective cohort was to explore the association of circulating glycer-AGEs with risk of colorectal cancer. Methods: A total of 1,055 colorectal cancer cases (colon n = 659; rectal n = 396) were matchced (1: 1) to control subjects. Circulating glycer-AGEs were measured by a competitive ELISA. Multivariable conditional logistic regression models were used to calculate ORs and 95% confidence intervals (95% CI), adjusting for potential confounding factors, including smoking, alcohol, physical activity, body mass index, and diabetes status. Results: Elevated glycer-AGEs levels were not associated with colorectal cancer risk (highest vs. lowest quartile, 1.10; 95% CI, 0.82-1.49). Subgroup analyses showed possible divergence by anatomical subsites (OR for colon cancer, 0.83; 95% CI, 0.571.22; OR for rectal cancer, 1.90; 95% CI, 1.14-3.19; Pheterogeneity = 0.14). Conclusions: In this prospective study, circulating glycer-AGEs were not associated with risk of colon cancer, but showed a positive association with the risk of rectal cancer. Impact: Further research is needed to clarify the role of toxic products of carbohydrate metabolism and energy excess in colorectal cancer development.
Afshar, A
Lange, M.
Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer2017Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, nr 11, s. 987-995Artikkel i tidsskrift (Fagfellevurdert)
Aim Previous research indicates that high tie of the inferior mesenteric artery during anterior resection for rectal cancer might be associated with an increased risk of postoperative functional disturbances. The goal of this population-based retrospective cohort study was to further investigate that association.
Method Patients who underwent anterior resection for rectal cancer from April 2011 to September 2012 were identified through the Swedish Colorectal Cancer Registry. Bowel and urogenital function were assessed by a postal questionnaire 2 years after surgery. Information on the level of mesenteric tie and clinical variables was retrieved from the registry. The outcome was defined as any defaecatory, urinary or sexual dysfunction as reported by the patient. The association between high tie and the outcome was evaluated with multivariable logistic and linear regression with adjustment for confounders, such as sex, body mass index, comorbidity and preoperative radiation.
Results With a response rate of 86%, 805 patients were included in the study. Of these, 46% were operated with high tie. After adjustment for confounders, high tie did not affect the risk of faecal incontinence (OR 0.85; 95% CI 0.59-1.22), urinary incontinence (OR 0.94; 95% CI 0.63-1.41) or various aspects of sexual dysfunction (erectile dysfunction, anejaculation, dyspareunia and coital vaginal dryness). However, an association between high tie and defaecation at night was detected (OR 1.44; 95% CI 1.02-2.03).
Conclusion This study does not support that the level of vascular tie influences the risk of major defaecatory, urinary or sexual disturbances 2 years after anterior resection for rectal cancer.
Angenete, E.
Lydrup, M. -L
Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer2017Inngår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, nr 10, s. 1908-1914Artikkel i tidsskrift (Fagfellevurdert)
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used in colorectal surgery due to their opioid-sparing effect. However, several studies have indicated an increased risk of anastomotic leakage following NSAID treatment, although conflicting results exist. The primary goal of this study was to further examine whether postoperative NSAIDs are independently associated with anastomotic leakage after anterior resection for rectal cancer. Methods: Patients who underwent anterior resection for rectal cancer during 2007-2013 in 15 different hospitals in three healthcare regions in Sweden were included in the study. Registry data and information from patient records were retrieved. The association between NSAID treatment (for at least two days in the first postoperative week) and symptomatic anastomotic leakage (within 90 days) was evaluated with multiple logistic regression, with adjustment for pertinent confounding factors. Results: Some 1495 patients were included in the study. Of these, 27% received postoperative NSAIDs for at least two days in the first postoperative week. Symptomatic anastomotic leakage occurred in 11% and 14% in the NSAID and non-NSAID group, respectively. With adjustment for confounders, the odds ratio for leakage among patients who received NSAIDs compared with those who did not was 0.88 (95% CI 0.65-1.20). No differences were seen between non-selective and COX-2-selective NSAIDs. Conclusion: Postoperative NSAID treatment does not seem to increase the risk of symptomatic anastomotic leakage after anterior resection for rectal cancer. NSAID use appears to be safe, but a well-powered randomized clinical trial is warranted.
Svensson, Johan
Jutesten, Henrik
Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
Department of	Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Lydrup, Marie-Louise
The Impact of Anastomotic Leakage on Long-Term Function after Anterior Resection for Rectal CancerManuskript (preprint) (Annet vitenskapelig)
Background It is still not clear whether anastomotic leakage after anterior resection for rectal cancer affects long-term functional outcome.
Objective To evaluate how anastomotic leakage following anterior resection for rectal cancer influences defecatory, urinary and sexual function.
Design In this retrospective population-based cohort study, patients were identified through the Swedish Colorectal Cancer Registry, which was also used for information on the exposure variable anastomotic leakage, and covariates.
Settings A nationwide register was used for including patients.
Patients All patients undergoing anterior resection for rectal cancer in Sweden from April 2011– June 2013 were included.
Main Outcome Measures Outcome was any defecatory, sexual or urinary dysfunction, assessed two years after surgery by a postal questionnaire. The association between anastomotic leakage and function was assessed in multivariable logistic and linear regression models, with adjustment for confounding.
Results Response rate was 82%, resulting in 1180 included patients. Anastomotic leakage occurred in 7.5%. A permanent stoma was more common among leak patients (44% vs. 9%; p<0.001). Leakage patients had an increased risk of aid use for fecal incontinence (OR 2.27; 95% CI 1.20-4.30) and reduced sexual activity (90% vs. 82%; p=0.003), while the risk of urinary incontinence was decreased (OR 0.53; 95% CI 0.31-0.90). A sensitivity analysis assuming that a permanent stoma was created due to anorectal dysfunction strengthened the negative impact of leakage on defecatory dysfunction.
Limitations Limitations include the used questionnaire not having been previously validated, underreporting of anastomotic leakage in the register, and small patient numbers in the analysis of sexual symptoms.
Conclusions Anastomotic leakage was found to statistically significantly increase the risk of aid use due to fecal incontinence and reduced sexual activity, though the impact on defecatory dysfunction might be underestimated, as permanent stomas are sometimes fashioned due to anorectal dysfunction. Further research is warranted, especially regarding urogenital function.
31. Larsson, Susanna C
Bergkvist, Leif
Näslund, Ingmar
Wolk, Alicja
Vitamin A, retinol, and carotenoids and the risk of gastric cancer: a prospective cohort study.2007Inngår i: Am J Clin Nutr, ISSN 0002-9165, Vol. 85, nr 2, s. 497-503Artikkel i tidsskrift (Fagfellevurdert)
Giovannucci, Edward
Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men.2006Inngår i: Am J Clin Nutr, ISSN 0002-9165, Vol. 83, nr 3, s. 667-73; quiz 728Artikkel i tidsskrift (Fagfellevurdert)
Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men.2006Inngår i: Eur J Cancer, ISSN 0959-8049, Vol. 42, nr 15, s. 2590-7Artikkel i tidsskrift (Fagfellevurdert)
Lindberg, J
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap.
Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi. Patologi.
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi. Kirurgi.
Surgery for neoplastic changes in ulcerative colitis - can limited resection be justified? Outcome for patients who underwent limited surgery.2006Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 8, nr 7, s. 551-556Artikkel i tidsskrift (Fagfellevurdert)
Early onset of ulcerative colitis: long-term follow-up with special reference to colorectal cancer and primary sclerosing cholangitis.2008Inngår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 46, nr 5, s. 534-538Artikkel i tidsskrift (Fagfellevurdert)
Efficiency of colorectal cancer surveillance in patients with ulcerative colitis: 26 years' experience in a patient cohort from a defined population area.2005Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 40, nr 9, s. 1076-1080Artikkel i tidsskrift (Fagfellevurdert)
37. Lindgren, Rickard
Does a defunctioning stoma affect anorectal function after low rectal resection?: Results of a randomized multicenter trial2011Inngår i: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, nr 6, s. 747-752Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: Anorectal function is often impaired after low anterior resection of the rectum. Many factors affect the functional outcome and not all are known.
OBJECTIVE: This trial aimed to assess whether a temporary defunctioning stoma affected anorectal function after the patients had been stoma-free for a year.
DESIGN: Multicenter randomized controlled trial.
SETTING: Twenty-one Swedish hospitals performing surgery for rectal cancer participated.
PATIENTS: Patients who had undergone low anterior resection for adenocarcinoma of the rectum were eligible.
INTERVENTIONS: Patients were randomly assigned to receive a defunctioning stoma or no stoma.
MAIN OUTCOME MEASURES: Anorectal function was evaluated with a questionnaire after patients had been without a stoma for 12 months. Questions pertained to stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and whether patients would prefer a permanent stoma.
RESULTS: After exclusion of patients in whom stomas became permanent, a total of 181 (90%) of 201 patients answered the questionnaire (90 in the stoma group and 91 in the no-stoma group). The median number of stools was 3 during the day and 0 at night in both groups. Inability to defer defecation for 15 minutes was reported in 35% of patients in the stoma group and 25% in the no stoma group (P = .15). Median scores were the same in each group regarding need for medication, evacuation difficulties, fragmentation of bowel movements, incontinence, and effects on well-being. Two patients (2.2%) in the stoma group and 3 patients (3.3%) in the no-stoma group would have preferred a permanent stoma.
LIMITATIONS: Because this study was an analysis of secondary end points of a randomized trial, no prestudy power calculation was performed.
CONCLUSIONS: A defunctioning stoma after low anterior resection did not affect anorectal function evaluated after 1 year. Many patients experienced impaired anorectal function, but nearly all preferred having impaired anorectal function to a permanent stoma.
What is the risk for a permanent stoma after low anterior resection of the rectum for cancer?: A six-year follow-up of a multicenter trial2011Inngår i: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, nr 1, s. 41-47Artikkel i tidsskrift (Fagfellevurdert)
PURPOSE: The aim of this study was to assess the risk for permanent stoma after low anterior resection of the rectum for cancer.
METHODS: In a nationwide multicenter trial 234 patients undergoing low anterior resection of the rectum were randomly assigned to a group with defunctioning stomas (n = 116) or a group with no defunctioning stomas (n = 118). The median age was 68 years, 45% of the patients were women, 79% had preoperative radiotherapy, and 4% had International Union Against Cancer cancer stage IV. The patients were analyzed with regard to the presence of a permanent stoma, the type of stoma, the time point at which the stoma was constructed or considered as permanent, and the reasons for obtaining a permanent stoma. Median follow-up was 72 months (42-108). One patient with a defunctioning stoma who died within 30 days after the rectal resection was excluded from the analysis.
RESULTS: During the study period 19% (45/233) of the patients obtained a permanent stoma: 25 received an end sigmoid stoma and 20 received a loop ileostomy. The end sigmoid stomas were constructed at a median of 22 months (1-71) after the low anterior resection of the rectum, and the loop ileostomies were considered as permanent at a median of 12.5 months (1-47) after the initial rectal resection. The reasons for loop ileostomy were metastatic disease (n = 6), unsatisfactory anorectal function (n = 6), deteriorated general medical condition (n = 3), new noncolorectal cancer (n = 2), patient refusal of further surgery (n = 2), and chronic constipation (n = 1). Reasons for end sigmoid stoma were unsatisfactory anorectal function (n = 22) and urgent surgery owing to anastomotic leakage (n = 3). The risk for permanent stomas in patients with symptomatic anastomotic leakage was 56% (25/45) compared with 11% (20/188) in those without symptomatic anastomotic leakage (P < .001).
CONCLUSION: One patient of 5 ended up with a permanent stoma after low anterior resection of the rectum for cancer, and half of the patients with a permanent stoma had previous symptomatic anastomotic leakage.
Patients with longstanding ulcerative colitis in remission do not have more irritable bowel syndrome-like symptoms than controls2016Inngår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 16, artikkel-id 139 Artikkel i tidsskrift (Fagfellevurdert)
BACKGROUND: Irritable bowel syndrome (IBS) is more common in patients with ulcerative colitis (UC) than expected. The prevalence of IBS in patients with UC with longstanding disease is not known. We investigated the prevalence of IBS-like symptoms in patients with UC in remission and longstanding disease in comparison to control subjects.
METHODS: Sixty-eight patients with UC and 33 patients with hereditary familiar colon cancer and who underwent colonoscopy surveillance were included. Faecal calprotectin (FC), Gastrointestinal Symptoms Rating Scale-Irritable Bowel Syndrome (GSRS-IBS) and Hospital Anxiety and Depression scale were fulfilled prior to endoscopy. UC in remission was define by steroid-free clinical remission, a Mayo Score ≤ 1 on endoscopy, a FC ≤ 200 μg/g and no significant active inflammation on colon biopsies.
RESULTS: Fifty-five UC patients met the criteria for being in remission. The median disease duration was 17 years. The patients with UC in remission tended to have lower scores on total GSRS-IBS score (6 vs 10.5; p = 0.062) and lower or equal scores on all specific IBS symptoms in comparison to controls. There was a moderate but significant correlation between diarrhoea scores and FC levels (in the span ≤ 200 μg/g) (rs 0.38; p = 0.004) in the UC in remission group.
CONCLUSION: Patients with UC with longstanding disease and in remission do not have more IBS symptoms than controls. In UC patients in remission the FC level in the lower span showed a moderate correlation to symptoms of diarrhoea.
40. Matthiessen, P
Hallböök, O
Andersson, M
Sjödahl, R
Risk factors for anastomotic leakage after anterior resection of the rectum.2004Inngår i: Colorectal Dis, ISSN 1462-8910, Vol. 6, nr 6, s. 462-9Artikkel i tidsskrift (Fagfellevurdert)
Intraoperative adverse events and outcome after anterior resection of the rectum.2004Inngår i: Br J Surg, ISSN 0007-1323, Vol. 91, nr 12, s. 1608-12Artikkel i tidsskrift (Fagfellevurdert)
Population-based study of risk factors for postoperative death after anterior resection of the rectum.2006Inngår i: Br J Surg, ISSN 0007-1323, Vol. 93, nr 4, s. 498-503Artikkel i tidsskrift (Fagfellevurdert)
43. Matthiessen, Peter
Simert, Göran
Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial.2007Inngår i: Ann Surg, ISSN 0003-4932, Vol. 246, nr 2, s. 207-14Artikkel i tidsskrift (Fagfellevurdert)
Hansson, Lena
Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer - occurrence and risk factors.2010Inngår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, ISSN 1463-1318, Vol. 12, nr 4, s. 351-357Artikkel i tidsskrift (Fagfellevurdert)
ABSTRACT Background The aim of the study was to assess recto-vaginal fistula after anterior resection of the rectum for cancer with regard to occurrence and risk factors. Methods All female patients (median age 69.5 years, UICC cancer stage IV in 10%) who developed a symptomatic recto-vaginal fistula (n=20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n=32), and those who did not leak (n=338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for recto-vaginal fistula (anastomotic-vaginal fistula) were analysed. Results Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL) of faeces. Patients with AVF required unscheduled reoperation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis <5cm above the anal verge (P=0.001), preoperative radiotherapy (P=0.004), and UICC cancer stage IV (P=0.005). Previous hysterectomy was not a risk factor for AVF nor for CL. Conclusion Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal reoperation and defunctioning stoma was not different from patients with conventional leakage. Risk factors for anastomotic-vaginal fistula included low anastomosis, preoperative radiotherapy, and UICC cancer stage IV.
Lindgren, Rickard
Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for cancer.2009Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318Artikkel i tidsskrift (Fagfellevurdert)
Background: The aim of this study was to investigate patients with symptomatic anastomotic leakage diagnosed after hospital discharge. Methods: Patients undergoing low anterior resection of the rectum for cancer (n=234) who were included in a prospective multicenter trial (NCT 00636948) and who developed symptomatic anastomotic leakage diagnosed after hospital discharge (late leakage, LL; n=18) were identified. These patients were assessed in regard to patient characteristics, operative details, recovery on postoperative day five, length of hospital stay, and how the leakage was diagnosed. A comparison with those who did not develop symptomatic leakage (no leakage, NL; n=189) was performed. Minimum follow up was 24 months. Results: Median age was 69 years, 61% were females, and 6% had UICC cancer stage IV in LL. On postoperative day 5, LL had a postoperative course similar to NL in regard to morning temperature, per oral intake and bowel activity. The proportion of patients being on antibiotic treatment on postoperative day 5, regardless of indication, was 28% in LL compared with 4% in NL (P<0.001). The initial hospital stay was median 10 days for both LL and NL. If adding readmission for any reason, planned or unplanned, hospital stay was median 21.5 and 13 days in LL and NL, respectively (P<0.001). Conclusion: Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection of the rectum for cancer is not uncommon and has an immediate clinical postoperative course which may appear uneventful.
Strand, Ida
Jansson, Kjell
Törnquist, Cathrine
Andersson, Magnus
Norgren, Lars
Is early detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer?2007Inngår i: Dis Colon Rectum, ISSN 0012-3706, Vol. 50, nr 11, s. 1918-27Artikkel i tidsskrift (Fagfellevurdert)
Näsvall, Pia
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital/Umeå University, 97180 Luleå, Sweden.
Dahlstrand, Ursula
Löwenmark, Thyra
Strigård, Karin
Quality of life in patients with a permanent stoma after rectal cancer surgery2017Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 1, s. 55-64Artikkel i tidsskrift (Fagfellevurdert)
AIM: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.
METHODS: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.
RESULTS: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.
CONCLUSION: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.
Quality of life with permanent stoma after rectal cancer surgeryManuskript (preprint) (Annet vitenskapelig)
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Sunderby Hospital, Luleå, Sweden.
Dahlberg, Michael
Department of Surgery, Sunderby Hospital, Luleå, Sweden.
Parastomal hernia repair with intraperitoneal mesh2017Inngår i: Surgery Research and Practice, ISSN 2356-7759, Vol. 2017, s. 51+4artikkel-id 8597463Artikkel i tidsskrift (Fagfellevurdert)
Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.
Reply to 'Preventing parastomal herniation in 2014 and beyond'2014Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 16, nr 10, s. 831-832Artikkel i tidsskrift (Fagfellevurdert)
Umeå universitetsbibliotek
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Q: How can I sum these two Spark Dataframes in Scala? I'm getting familiar with Spark and Scala and my current task is to "sum" these two Dataframes:
+---+--------+-------------------+
|cyl|avg(mpg)|      var_samp(mpg)|
+---+--------+-------------------+
|  8|    15.8| 1.0200000000000014|
|  6|    20.9|0.48999999999999966|
|  4|    33.9|                0.0|
+---+--------+-------------------+

+---+------------------+------------------+
|cyl|          avg(mpg)|     var_samp(mpg)|
+---+------------------+------------------+
|  8|             13.75| 6.746999999999998|
|  6|              21.4|               NaN|
+---+------------------+------------------+

In this case the "key" is cyl and the "values" avg(mpg) and var_samp(mpg).
The (approximate) result for these two would be:
+---+--------+-------------------+
|cyl|avg(mpg)|      var_samp(mpg)|
+---+--------+-------------------+
|  8|   29.55|            7.76712|
|  6|    42.3|0.48999999999999966|
|  4|    33.9|                0.0|
+---+--------+-------------------+

Notice how NaN is considered to be zero and also how there might be "keys" missing in some DataFrames, (4 key is missing in the second).
I suspect reduceByKey to be the way to go here but can't make it work.
Here is my code so far:
case class Cars(car: String, mpg: String, cyl: String, disp: String, hp: String,
                drat: String, wt: String, qsec: String, vs: String, am: String, gear: String, carb: String)

object Bootstrapping extends App {
  override def main(args: Array[String]) {
    val conf = new SparkConf().setAppName("Spark and SparkSql").setMaster("local")
    val sc = new SparkContext(conf)

    sc.setLogLevel("WARN")

    // Exploring SparkSQL
    // Initialize an SQLContext
    val sqlContext = new org.apache.spark.sql.SQLContext(sc)
    import sqlContext._
    import sqlContext.implicits._

    // Load a cvs file
    val csv = sc.textFile("mtcars.csv")
    // Create a Spark DataFrame
    val headerAndRows = csv.map(line => line.split(",").map(_.trim))
    val header = headerAndRows.first
    val mtcdata = headerAndRows.filter(_(0) != header(0))
    val mtcars = mtcdata
      .map(p => Cars(p(0), p(1), p(2), p(3), p(4), p(5), p(6), p(7), p(8), p(9), p(10), p(11)))
      .toDF

    // Aggregate data after grouping by columns
    import org.apache.spark.sql.functions._

    mtcars.sort($"cyl").show()
    mtcars.groupBy("cyl").agg(avg("mpg"), var_samp("mpg")).sort($"cyl").show()

    //sample 25% of the population without replacement
    val sampledData = mtcars.sample(false, 0.25)

    //bootstrapping loop
    for (a <- 1 to 5) {

      //get bootstrap sample
      val bootstrapSample = sampledData.sample(true, 1)

      //HERE!!! I WANT TO SAVE THE AGGREGATED SUM OF THE FOLLOWING:
      bootstrapSample.groupBy("cyl").agg(avg("mpg"), var_samp("mpg"))

    }

  }
}

This is the data I'm using: Motor Trend Car Road Tests

A: One approach would be to union the two DataFrames, use when/otherwise to translate NaN, and perform groupBy to aggregate the sums of the columns, as shown below:
import org.apache.spark.sql.functions._
import spark.implicits._

val df1 = Seq(
  (8, 15.8, 1.0200000000000014),
  (6, 20.9, 0.48999999999999966),
  (4, 33.9, 0.0)
).toDF("cyl", "avg_mpg", "var_samp_mpg")

val df2 = Seq(
  (8, 13.75, 6.746999999999998),
  (6, 21.4, Double.NaN)
).toDF("cyl", "avg_mpg", "var_samp_mpg")

(df1 union df2).
  withColumn("var_samp_mpg", when($"var_samp_mpg".isNaN, 0.0).otherwise($"var_samp_mpg")).
  groupBy("cyl").agg(sum("avg_mpg"), sum("var_samp_mpg")).
  show
// +---+------------+-------------------+
// |cyl|sum(avg_mpg)|  sum(var_samp_mpg)|
// +---+------------+-------------------+
// |  6|        42.3|0.48999999999999966|
// |  4|        33.9|                0.0|
// |  8|       29.55| 7.7669999999999995|
// +---+------------+-------------------+