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High-risk stage II colon cancer is defined in European and American guidelines as the presence of at least one of the following high-risk factors: T4 stage, tumor differentiation grade 3, bowel obs...

To analyze the results of abdominoperineal excisions (APE) for locally advanced rectal cancer at our institution before and after the adoption of extralevator abdominoperineal excision (ELAPE) with a special reference to long-term survival. A retrospective cohort study conducted in a tertiary referral center. All consecutive patients operated for locally advanced (TNM classification T3–4) rectal cancer with APE in 2004–2009 were compared to patients with similar tumors operated with ELAPE in 2009–2016. Forty-two ELAPE and 27 APE patients were included. Circumferential resection margin (CRM) was less than 1 mm (R1-resection) in 10 (24%) of ELAPE patients and 11 (41%) of APE patients (p = 0.1358). Intraoperative perforation (IOP) occurred in 4 (10%) patients and 6 (22%) patients in ELAPE and APE groups, respectively (p = 0.1336). There were 3 (7%) local recurrences (LRs) in ELAPE group and 5 (19%) in APE (p = 0.2473). There were no statistical differences in adverse events, overall survival, or disease-free survival between ELAPE and APE groups. We found a non-significant tendency to lower rates of IOP and positive CRM as well as lower rate of LR in the ELAPE group. Long-term survival and adverse events did not differ between the groups. ELAPE is beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. These technical aspects and the clinically very important tendency to lower rate of LR support the use of ELAPE technique in spite of the lack of survival benefit.

Background: Most survival data in colorectal cancer (CRC) is derived from clinical trials or register-based studies. Hospital Biobanks, linked with hospital electronic records, could serve as a data-gathering method based on consecutively collected tumor samples. The aim of this Biobank study was to analyze survival of colorectal patients diagnosed and treated in a single-center university hospital over a period of 12 years, and to evaluate factors contributing to outcome.Material and methods: A total of 1777 patients with CRC treated during 2001-2012 were identified from the Auria Biobank, Turku, Finland. Longitudinal clinical information was collected from various hospital electronic records and date and cause of death obtained from Statistics Finland.Results: Cancer-specific, overall and disease-free survival was higher in patients diagnosed during 2004-2008 as compared with patients diagnosed in 2001-2003. Further improvement was not seen during years 2009-2012. Potential factors contributing to the improvement were introduction of multidisciplinary meetings, centralization of rectal cancer surgery, use of adjuvant chemotherapy and systematic preoperative radiotherapy of rectal cancer. The proportion of patients with stage I-IV CRC remained similar over the study period, but a marked decrease in non-metastatic rectal cancer with biopsy only (locally advanced disease) was observed. In stage I-III rectal cancer, Cox multivariate analysis suggested age, comorbidity, R1 resection, T staging and tumor grade as prognostic factors. In colon cancer, prognostic factors were age, comorbidity, gender and presence of lymph node metastases.Conclusions: Organizational changes in the treatment of CRC patients made since 2004 coincide with improved survival in CRC and a marked reduction in locally advanced rectal cancers. The clinical presentation of CRC has remained similar between 2001 and 2012.

Background and Aims: Laparoscopic cholecystectomy (LC) via three or four ports has been the standard operation for gallstone disease. Recently, the development of multichannel port devices has allowed LCs to be performed through a single fascial incision in the umbilicus. Here, we report our experiences of the adoption of the single incision laparoscopic cholecystectomy (SILC) in two small-volume community hospitals. Material and Methods: From January until July 2010, 51 consecutive patients (41 females and 10 males, the mean age 44 (21–75) years, BMI 26 (18–35)) underwent elective SILC for symptomatic gallstone disease in Salo (n = 29) and Loimaa (n = 22) hospitals. Results: Of the 51 operations, 42 (82%) were accomplished without additional troacars. Seven (14%) procedures were converted to multiple-port technique and two (4%) to open cholecystectomy. In 25 (49%) operations, transabdominal retraction sutures through the gallbladder were used to maintain a good view of the triangle of Calot. The mean operative time was 74 (31–155) min. No major intraoperative complications occurred. The mean hospital stay was 0.6 (0–3) days. During a mean follow up of 4 (1–7) months, five (10%) patients had wound infection, and one (2%) had hematoma and prolonged pain in the insertion site of the retraction suture. One (2%) patient was reoperated for continuous pain in umbilical wound without findings at operation but with good results. One (2%) patient had subphrenic abscess seven months postoperatively. Conclusions: Our initial experiences indicate that SILC can be adopted without major complications in small-volume hospitals but the rate of wound infections seems to increase with the introduction of SILC.

This paper presents a clock generator circuit for a high-speed analog-to-digital converter (ADC). A time-interleaved ADC requires accurate clocking for the converter fingers. The target ADC has 12 interleaved fingers each running at a speed of 166 MS/s, which corresponds to an equivalent sampling frequency of 2 GS/s. A delay-locked loop (DLL) based clock generator has been proposed to provide multiple clock signals for the converter. The DLL clock generator has been implemented with a 0.35 ?m SiGe BiCMOS process (only MOS-transistor were used in DLL) by Austria Micro Systems and it occupies a 0.6 mm2 silicon area. The measured jitter of the DLL is around 1 ps and the delay between phases can be adjusted using 1 ps precision.

A low noise 0.9 GHz FBAR clock consisting of an oscillator and divider circuit for single-sided-to-differential conversion for a high-speed interleaved pipeline A/D-converter was designed, realized with an in-house FBAR and a commercial 0.35 ?m CMOS process, and tested. The circuit showed very good jitter and phase noise performance. A temperature coefficient of ---47 ppm/K was measured.

Digital-to-analog converts utilizing neuron MOS-transistors were designed. Different DACs were implemented and characterized in order to compare various topologies. Criteria to select structures were low power, fast performance and minimal silicon area. A basic 8-bit version is implemented with only one neuron MOS-transistor and eight capacitors. The silicon area of this D/A converter is only 0.04\,{\rm mm}^{2} and the power consumption is 8.4 mW with conversion speed of 200 MS/s. An enhanced 8 and 10 bit versions utilizing neuron PMOS transistor and some extra circuitry are also proposed and tested. The silicon area of the enhanced 10 bit circuit is only 0.03\,{\rm mm}^{2} while the performance is as good as in the case of the basic version. The measured differential nonlinearity is 0.38 LSB and integral nonlinearity is 0.55 LSB for the enhanced 10 bit structure.

A 16 input and 16 output channels single chip intermediate frequency range (160 MHz) analog switch matrix for personal communication satellites has been designed and processed by using a commercial 1.2 µm BiCMOS technology. The circuit has low power consumption (

Background and aims: Recent advances in surgical techniques and adjuvant treatments have decreased morbidity and mortality in patients with rectal cancer. The aim of this study was to clarify the effects of aging on the choice, feasibility and safety of various treatment modalities in patients with rectal cancer. Patients and methods: During 2003–2006, a total of 274 rectal cancers were diagnosed at Turku University Central Hospital. Patient and tumor characteristics, treatment modalities chosen, and complications were recorded, and patients were followed up prospectively for 1–3 years after treatment. Patients were then divided into two groups: under 75 (n=181) and 75 years or older (n=93) at the moment of diagnosis. Patient data in the two age groups were analysed and compared with each other. Results: Of the total of 274 patients with rectal cancer, 243 (89%) underwent surgery. The percentage of patients operated was higher (pp=0.03) in the younger (92%) than in the older group (83%). The main reasons for non-operative or palliative treatment were severe concomitant diseases and metasta-sized cancer. Preoperative radiation therapy was given more often (p

Adhesion to the intestinal mucosa is one of the main selection criteria for probiotics. The influence of the endogenous intestinal microbiota on this adhesion has been little investigated. Therefore, the adhesion of five selected probiotic strains to human intestinal mucus with an endogenous microbiota and with a reduced microbiota was assessed. Of the five tested strains, two were found to exhibit an increased adhesion to intestinal mucus with a reduced microbiota. These results suggest that the endogenous mucosal microbiota may only slightly affect the initial adhesion of selected probiotics to intestinal mucus. Key words: probiotic, intestinal mucus, mucosal microbiota, adhesion.

The neuron MOS transistor is a recently discovered device which is capable of executing a weighted sum calculation of multiple input signals and threshold operation based on the result of summation, thereby simulating the function of biological neurons. A comprehensive set of neuron test transistors has been designed, where a number of input gates are coupled capacitively to a floating gate, which controls the channel current. Integrated circuits for neural network applications have also been designed, based on the neuron MOS transistors. These circuits include neuron CMOS inverters and A/D and D/A converters. To increase the accuracy of the neuron MOSFET structures, calibration techniques are proposed and tested. All the test structures and circuits are implemented by using a standard 0.8 /spl mu/m double-polysilicon CMOS technology. Attention was paid to saving the layout area and reducing power consumption.

Background As a predominant beta-adrenergic agonist, dobutamine may modify blood flow distribution and increase metabolic demands. The authors investigated the effect of a dobutamine-induced increase in cardiac output on splanchnic and femoral blood flow and metabolism in patients after cardiac surgery. Methods Seventeen stable patients were randomized to receive dobutamine or placebo (n = 8 per group, one dropout). After baseline measurement for systemic, splanchnic, and femoral blood flow (by dye dilution); oxygen consumption; gastric mucosal pressure of carbon dioxide (Pco2); total and splanchnic glucose production (by stable isotope tracer dilution); and regional lactate and amino acid balance, patients received either dobutamine, at a dosage (6 microg x kg(-1)min(-1)) sufficient to increase cardiac index by at least 25%, or placebo. A second set of measurements was performed 60 min after the start of dobutamine or placebo infusion. Results Dobutamine increased cardiac index (3.0+/-0.6 to 4.4+/-1.0 l x min(-1)m(-2), mean +/- SD; P < 0.05), splanchnic blood flow (from 0.8+/-0.2 to 1.0 + 0.2 l x min(-1)m(-2); P < 0.05), femoral blood flow (from 0.2+/-0.1 to 0.3+/-0.1 l x min(-1)m(-2); P < 0.05), and the arterial-gastric mucosal Pco2 gap (from 11.4+/-9.5 to 11.9+/-8.0 mmHg; P < 0.05). Dobutamine increased systemic oxygen consumption (from 132+/-14 to 146+/-13 ml x min(-1) x m(-2); P < 0.05) but not splanchnic or femoral oxygen consumption. Splanchnic glucose production and lactate and amino acid balance did not change. Conclusion After coronary artery bypass surgery, dobutamine increased systemic and regional blood flow and decreased systemic and regional oxygen extraction. Dobutamine did not affect splanchnic glucose production or lactate or amino acid balance. This suggests that dobutamine increases splanchnic blood flow without a concomitant increase in hepatosplanchnic metabolism.

Improved structures for neuron MOSFETs, which can execute a weighted summation of multiple input signals, are proposed and tested. Both an additional polysilicon shield and a substrate biasing show good control of the turning point of the neuron MOSFET inverters fabricated using a double poly-CMOS technology. The improved accuracy is demonstrated by fabricating A/D converter circuits utilising the neuron MOSFETs.