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Objective Patients with clinical T1 renal cell carcinoma (cT1RCC) have risks for recurrence and reduced overall survival despite being in the best prognostic group. This study aimed to evaluate the association of different treatments on disease recurrence and overall survival using clinical and pathological characteristics in a nation-wide cT1RCC cohort. Materials and methods A total of 4,965 patients, registered in the National Swedish Kidney Cancer Register (NSKCR) between 2005 and 2014, with ≥ 5-years follow-up were identified: 3,040 males and 1,925 females, mean age 65 years. Times to recurrence and overall survival were analyzed with Kaplan-Meier curves, log-rank test, and Cox regression models. Results Age, TNM-stage, tumor size, RCC-type, and performed treatment were all associated with disease recurrence. Patients selected for ablative treatments had increased risk for recurrent disease: hazard ratio (HR) = 3.79 [95% confidence interval (CI) = 2.69–5.32]. In multivariate analyses, age, gender, tumor size, RCC-type, N-stage, recurrence and performed treatment were all independently associated with overall survival. Patients with chRCC had a 41% better overall survival (HR = 0.59, 95% CI = 0.44–0.78; p < 0.001) than ccRCC. Patients treated with partial nephrectomy (PN) had an 18% better overall survival (HR = 0.83, 95% CI = 0.71–0.95, p < 0.001) than patients treated with radical nephrectomy. Conclusions Age, gender, T-stage, tumor size, RCC type and treatment modality are all associated with risk of recurrence. Furthermore, age, male gender, tumor size, N-stage and recurrence are associated with reduced overall survival. Patients with chRCC, compared with ccRCC and pRCC patients, and PN compared with RN treated patients, had an advantageous overall survival, indicating a possible survival advantage of nephron sparing treatment.

QC 20240212

OBJECTIVE: Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality following different surgical procedures and thermal ablation for renal cell carcinoma (RCC). MATERIAL AND METHODS: All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death. RESULTS: The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively. CONCLUSIONS: In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.

Researchers emphasise the importance for early childhood teacher education (ECTE) to promote positive attitudes towardsmathematics (Hollingsworth & Knight McKennas, 2018). The aim of this study is to investigate preservice teachers' attitudes totowards mathematics, whether and how attitudes change during ECTE and what might cause the changes. Previous research showsthat many preservice and early childhood teachers have low self-confidence and negative attitudes towards mathematics (Gresham& Burleigh, 2019; Hollingsworth & Knight McKenna, 2018; Linder & Simpson, 2018; Palmer, 2010). These negative attitudesinfluence their teaching of mathematics, which in turn affects children’s possibilities to learn (Geist, 2015; Knaus, 2017; Linder &Simpson; 2018; Youmans et al., 2018). We use the concept of attitude and adopt a multidimensional definition, where cognitive aswell as affective and behavioral components are included (Wen & Dube, 2022). We will use a short form of Tapia and Marsh's (2004)Attitudes Towards Mathematics Inventory (ATMI) questionnaire, developed and tested by Lim and Chapman (2013), together withcomplementing open questions. Ethical considerations are made according to the guidelines of the Swedish Research Council (2017).Based on the results, we will describe preservice teachers' attitudes towards mathematics during different parts of their education,as well as what influences these and how ECTE can contribute to promoting positive attitudes. The study can provide knowledgeabout how ECTE can support the development of positive attitudes towards mathematics, with the ultimate aim to enable earlychildhood education teachers to teach mathematics using children’s curiosity and interest.

PURPOSE: To assess the long-term risks of infectious and thromboembolic events following inguinal (ILND) and pelvic (PLND) lymph node dissection in men with penile cancer. MATERIAL AND METHODS: A total of 364 men subjected to ILND with or without PLND for penile cancer between 2000 and 2012 were identified in the Swedish National Penile Cancer Register. Each patient was matched based on age and county of residence with six penile cancer-free men. The Swedish Cancer Register and other population-based registers were used to retrieve information on treatment and hospitalisation for selected infectious and thromboembolic events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with multiple imputation. RESULTS: The risk of infectious events remained increased for more than five years postoperatively in men with penile cancer compared with matched controls. The palpable nodal disease was the only predictor of these events, with risk increasing with the cN stage. The HR at one, three and five years and six months postoperatively was 8.60 (95% CI 5.16-14.34), 4.02 (95% CI 2.65-6.09) and 1.93 (95% CI 1.11-3.38), respectively. An increased risk of thromboembolic events persisted for three years postoperatively. The HR at one and three years postoperatively was 13.51 (95% CI 6.53-27.93) and 2.12 (95% CI 1.07-4.20). The results correspond well with the over-prescription of anticoagulants observed during this period. An association with bulky disease (cN3) was observed. CONCLUSIONS: Lymph node dissection for penile cancer is associated with an increased risk of infectious and thromboembolic events. The findings of this population-based study show that the risks of these events remain increased more than five years for infectious and three years for thromboembolic events. Improved awareness of long-term complications following ILND is of importance both among patients and care givers to ensure early detection and treatm

The competence and knowledge of the preschool teacher is the most important factor for how the teaching is organised, and what the children are given opportunities to learn. For teaching technology, technological literacy (TL) constitutes such a competence. The TPI was created from a phenomenographic study on upper secondary students in South Africa and has thereafter been tested and validated for several groups of students in South Africa. We used the TPI to test the TL of 184 preschool teachers and childcare attendants. To test the validity and reliability of the instrument in this context, we performed an exploratory factor analysis followed by a test of internal consistency using Cronbach alpha. This resulted in five factors/categories, two for conceptions of technology and three for interaction with technology: Technology is conceived of as an artefact or a process, and interaction with technology is through direction, instruction or tinkering. This differs somewhat from the categories presented by Luckay and Collier-Reed. We discuss possible reasons for this. The technological profile of the preschool staff was then explored for the group by calculating the mean score for each category. Regarding the conceptions of technology, the scores for artefact and process are similar, implying that the preschool staff view technology as both artefacts and a process. For the interaction with technology, the category instruction got the highest score, followed by tinkering, while the score for direction was considerably lower. This shows an unafraid and curious approach to technological objects, which can be considered valuable in the teaching of technology.

Objective: To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. Patients and methods: This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. Results: During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02–1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01–1.04; p < 0.001) and 1.05 (95% CI = 1.02–1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. Conclusions: Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.

Background: T1a renal cell carcinoma (RCC) is typically considered a curable disease, irrespective of the choice of local treatment modality. Objective: To identify factors associated with the risk of local and distant recurrence, and overall survival (OS) in patients with primary nonmetastatic clinical T1a RCC. Design, setting, and participants: A population-based nationwide register study of all 1935 patients with cT1a RCC, diagnosed during 2005–2012, identified through The National Swedish Kidney Cancer Register, was conducted. Outcome measurements and statistical analysis: Outcome variables were recurrence (local or distant) and OS. Possible explanatory variables included tumor size, RCC type, T stage, surgical technique, age, and gender. Associations with disease recurrence and OS were evaluated by multivariable regression and Cox multivariate analyses, respectively. Results and limitations: Among 1935 patients, 938 were treated with radical nephrectomy, 738 with partial nephrectomy, and 169 with ablative treatments, while 90 patients had no surgery. Seventy-eight (4%) patients were upstaged to pT3. Local or metastatic recurrences occurred in 145 (7.5%) patients, significantly more often after ablation (17.8%). The risk of recurrence was associated with tumor size, upstaging, and ablation. Larger tumor size, disease recurrence, and older age adversely affected OS, whereas partial nephrectomy and chromophobe RCC (chRCC) were associated with improved survival. Limitations include register design and a lack of comorbidity or performance status data. Conclusions: Upstaging and recurrence occurred, respectively, in 4.0% and 7.5% of patients with nonmetastatic RCCs ≤4 cm. Tumor size upstaging and ablation were associated with the risk for recurrence, while tumor size and recurrence were associated with decreased OS. Patients with chRCC and partial nephrectomy had prolonged OS in a real-world setting. Patient summary: We studied factors that may influence the risk of

Objective To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. Patients and methods This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. Results During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02-1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01-1.04; p < 0.001) and 1.05 (95% CI = 1.02-1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. Conclusions Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.

CD163+ M2 macrophages have been suggested to counteract tumor immunity by increasing immunosuppressive mechanisms including PD-L1 and IL-10 expression. Soluble levels of PD-L1, IL-10, and CD163 have been reported as potential biomarkers in various cancers, although the prognostic value in renal cell carcinoma (RCC) has to be further elucidated. In the present study, we measured the levels of sPD-L1, sIL-10, and sCD163 in 144 blood samples from patients with RCC. The levels were determined by using enzyme linked immunosorbent assays. Soluble PD-L1 and CD163 were detectable in 100% of the serum samples, and sCD163 in 22% of the urine samples, while only a minority of the samples had detectable sIL-10. Significantly higher serum levels of sPD-L1 and sCD163 were observed in patients with metastatic disease (p < 0.05). The results also showed that patients with high levels of sPD-L1 in serum had shorter cancer-specific survival compared with patients with low levels (p = 0.002). The results indicate that sPD-L1 most significantly reflects tumor progression in RCC.

OBJECTIVE: The aim of this study was to compare diagnostic and infectious outcomes between MRI-guided transrectal (TR) and transperineal (TP) prostate biopsies, in order to evaluate implementation of local-anaesthesia TP biopsies in a Swedish university hospital setting. METHODS: In this non-randomized observational study, we recruited 105 patients who underwent TR or TP software-based MRI-ultrasound fusion prostate biopsies between April and August 2020. Information on outcome and covariates were obtained from hospital records. We compared detection rates of overall prostate cancer (PCa) and clinically significant PCa (≥ISUP2) between the two groups using simple and multivariable-adjusted analyses. As a secondary outcome, we descriptively compared infection-related outcomes between the two groups. RESULTS: Of the total population, 72 patients underwent TR and 33 patients underwent TP biopsies. Biopsies were positive for PCa in 50 (69.4%) patients of the TR group and 23 (69.7%) patients of the TP group. Clinically significant cancer was found in 28 (38.9%) patients of the TR group and 10 (30.3%) patients of the TP group. Simple and multivariable-adjusted analyses did not indicate any statistically significant difference between groups. Post-biopsy infection was diagnosed in one patient (3%) of the TP group and eight patients (11.1%) in the TR group, conforming to previous reports of low infection rates after TP biopsies. CONCLUSIONS: Our results conform to data suggesting that the transition from TR to TP MRI-guided biopsies is feasible and safe, maintaining a high diagnostic quality while possibly reducing the risk of infection-related complications.

INTRODUCTION: The National Swedish Kidney Cancer Register (NSKCR) was launched in 2005. It is used for health care quality improvement and research. The aim of this study was to validate the register's data quality by assessing the timeliness, completeness, comparability and validity of the register. MATERIAL AND METHODS: To assess timeliness we evaluated the number of days between date of diagnosis and date of reporting the patient to the NSKCR. For completeness, we used data on number of cancer cases reported to the NSKCR compared to cases reported to the Swedish Cancer Register. Comparability was evaluated by reviewing coding routines and comparing data collected in the NSKCR to national and international guidelines. Validity was assessed by reabstraction of data from medical charts from 431 randomly selected patients diagnosed in 2007, 2010, 2013 and 2016. RESULTS: Timeliness has improved since the register started. In 2016, 76.9% and 96.5% of the patients were reported within 6 and 12 months respectively. Completeness was high, with a 99.5% coverage between 2008 and 2017. Registration forms and manuals were updated according to national and European guidelines. Improvements have been made continuously to decrease the risk of reporting mistakes and misunderstandings. Validity was high where a majority of the variables demonstrated an exact agreement >90% and few missing values. CONCLUSION: Overall, the data quality of the NSKCR is high. Completeness, comparability and validity is high. Timeliness can be further improved, which will make it easier to follow changes and improve the care and research of RCC patients., Funding Agencies:Swedish government cCunty councils (ALF-agreement)

OBJECTIVES: To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. MATERIALS AND METHODS: From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. RESULTS: In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0-6.4%) after open surgery and 2.4% (95% CI = 1.0-3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. CONCLUSIONS: Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.

Background: Recently, the CARMENA and SURTIME studies, suggested that upfront cytoreductive nephrectomy (CN) should be abandoned for patients with intermediate and high-risk metastatic renal cell carcinoma (mRCC). However, CN remains an indication in low-risk and when immediate systemic treatment is not required. The aim was to evaluate the long-term overall survival (OS) in patients with primary mRCC, based on the first line treatment. Methods: There were 1483 patients with primary mRCC in the National Kidney Cancer Registry from 2005 to 2013. Data on primary treatment, TNM stage, RCC type, tumor size, patient age and sex were extracted. Survival time was calculated from time of diagnosis to time of death or until July 2019. Mann-Whitney U and Chi-square tests, the Kaplan-Meyer method and Cox regression analyses were used. Results: Patients primary treated with CN had a significantly longer OS (p < .001) than patients primary treated with systemic therapy or palliation. In a Cox regression multivariate analysis, the hazard ratio for CN compared with no CN was 1.600, 95%Ci (1.492 − 1.691), p < .001. Also occurrence of lymph node metastases, T-stage, patients age and year of diagnosis, remained as independent predictors of OS. Conclusion: Patients primary treated with CN survived significantly longer than patients primary treated with systemic therapy or palliation, in all age groups. CN was an important first-line treatment option in mRCC patients.

Introduction: In 2005, the National Swedish Kidney Cancer Register (NSKCR) was set up to collect data on newly diagnosed patients with renal cell carcinoma (RCC). In 2015, the NSKCR was linked to a number of national healthcare and demographic registers to construct the Renal Cell Cancer Database Sweden (RCCBaSe). The aim was to facilitate research on trends in incidence, effects of treatment and survival, with detailed data on tumour characteristics, treatment, pharmaceutical prescriptions, socioeconomic factors and comorbidity. Material and methods: All patients registered in the NSKCR between 2005 and 2014 were included. For each case, ten controls and first-degree relatives for cases and controls were identified. The RCCBaSe was created linking all cases, controls and first-degree relatives to a number of national registers with information on co-morbidity, socioeconomic factors and pharmaceutical prescriptions. Results: Between 2005 and 2014, a total of 9,416 patients with RCC were reported to the NSKCR. 94,159 controls and a total cohort of 575,007 individuals including cases, controls and first-degree relatives were identified. Linkage to the Swedish cancer register resulted in 106,772 matches. When linked to the National patient register, 432,677 out-patient and 471,359 in-patient matches were generated. When linked to the Swedish renal registry 1,778 matches were generated. Linkage to the Prescribed drug register resulted in 448,084 matches and linkage to the The Longitudinal integration database for health insurance and labour market studies database resulted in 450,017 matches. Conclusion: By linking the NSKCR to several Swedish national databases, a unique database for RCC research has been created.

Developments in early childhood education (ECE) over the last two decades have for many countries meant a change towards a more subject-oriented pedagogy in which preschool staff are commissioned to teach technology to young children. This has been proved to be a challenge to the staff. Through analysis of activities at two preschool units, this study shows how technology education can be provided in ECE, and what kind of knowledge-learning by children can be facilitated in different activities and depending on the actions of the staff. An ethnographically inspired perspective was employed, using methods such as participant observation and formal and informal interviews, in order to investigate the technological knowledge encouraged by the staff at two preschool units in Sweden. The results show that staff promote children’s learning of a variety of technological content, mainly relating to technological objects and creative processes. This range from simple knowledge of how to handle a knife or a pair of scissors to more complex knowledge of how to build something to be fit for purpose and how different tools or materials are more or less adequate for a specific activity or design. The result also show that the way in which the staff address these contents effect which abilities and skills children are promoted to develop.