Maatalousalueiden perattujen purojen luonnonmukainen kunnostus ja hoito - kohti kestävämpiä maatalouden kuivatuskäytäntöjä

Maatalouden kuivatustoimenpiteet ovat muuttaneet voimakkaasti puroluonnon tilaa maassamme. Suoristetut ja peratut uomat kärsivät heikosta vedenlaadusta, virtaamien äärevöitymisestä ja tulvadynamiikan muutoksista sekä uomamorfologian yksipuolistumisesta ja eliöstön elinolosuhteiden heikkenemisestä. Peratut ja suoristetut purot ovat myös maisemallisesti hyvin yksipuolisia. Uomista joudutaan poistamaan lietettä säännöllisesti uomien kuivatus- ja tulvasuojeluhyötyjen säilyttämiseksi. Uudelleenkaivulisää kustannuksia ja heikentää entisestään peltouomien eliöstön elinolosuhteita ja alapuolisten vesistöjen veden laatua.Suomen ympäristökeskus käynnisti vuonna 2005 tutkimushankkeen "Maatalousalueiden perattujen purojen luonnonmukainen kunnostus ja hoito" yhteistyössä Uudenmaan ympäristökeskuksen, Uudenmaan TE-keskuksen ja Riista- ja kalatalouden tutkimuskeskuksen kanssa. Hankkeessa selvitetään mahdollisuuksia maatalousalueiden pienten, peruskuivatuksessa muutettujen uomien tilan parantamiseen. Hankkeen aikana kunnostetaan yhdeksän maatalousalueiden kuivatustoimista kärsinyttä koekohdetta ympäri maata. Keskeisin testattavista menetelmistä on uomien kaksitasoinen poikkileikkaus, jossa pieni, mutkitteleva alivesiuoma takaa eliöstölle riittävät vedenkorkeudet myös alivirtaamilla.Alivesiuomaa ympäröivät tulvatasanteet, jotka puolestaan varmistavat uoman vedenjohtokyvyn tulvavirtaamien aikana. Muita menetelmiä ovat syöpymistä ehkäisevät pohjakynnykset sekä uoman kunnostus kevyempien toimenpiteiden avulla, pääosin uoman omaa kulumisen ja kasautumisen dynamiikkaa hyödyntämällä. Tutkimuksessa arvioidaan myös kunnostusmenetelmien käytöstä seuraavia taloudellisia, ekologisia ja maisemallisia vaikutuksia.Uomien kunnostuksilla voidaan saavuttaa monia vedenlaadullisia, ekologisia, maisemallisia ja taloudellisia hyötyjä. Merkittävimpiä vaikutuksia ovat uomien ja niiden alapuolisten vesistöjen veden laadun paraneminen sekä uoman rakenteen, virtausolojen ja eliöstön monipuolistuminen. Koti- ja ulkomaisten (esim. tanskalaisten) kokemusten mukaan maatalousalueiden uomilla voi olla tärkeä ekologinen ja taloudellinen merkitys puro- ja meritaimenen sekä rapujen elinympäristönä. Purovesistön kunnostamisesta on konkreettista hyötyä myös viljelijöille, sillä uoman uudenlainen rakenne parantaa uoman itsepuhdistuskykyä ja vähentää liettymisestä aiheutuvaa uomien uudelleenperkaustarvetta.Monimuotoiset uomat ovat tärkeitä myös maisemallisesti ja vesistöjen virkistyskäytön kannalta. Maatalouden vesiensuojelutoimenpiteet, kuten suojavyöhykkeiden perustaminen, kosteikkojen rakentaminen ja pienimuotoisten tulva-alueiden palauttaminen tukevat uomien kunnostamista ja lisäävät uomien ja niiden lähialueiden ekologista ja maisemallista merkitystä.Ympäristön tilan huomioiminen sisältyy uusiin ojitustoimitusohjeisiin ja sen merkitys tulee entisestään korostumaan maatalouden ympäristötukijärjestelmän- ja peruskuivatuksen ohjeiden uudistamisen yhteydessä. Uudet ohjeet sitovat kaikkia, mutta käytännön hankkeiden yhteydessä toteutettujen esimerkkikohteiden puuttuessa luonnonmukaisten toimenpiteiden käyttö on jäänyt hyvin vähäiseksi. Tämän tutkimuksen keskeisenä tavoitteena on tarkastella luonnonmukaisten menetelmien käytöstä aiheutuvia vaikutuksia käytännössä ja tuloksia hyödyntäen tuottaa ohjeita ja suosituksia maatalousalueiden purojen kestävää käyttöä ja hoitoa varten. Näin varmistetaan uusien, ympäristön kannalta kestävämpien käytäntöjen saaminen osaksi modernin maatalouden kuivatuskäytäntöjä

Genetic predisposition to uterine leiomyoma is determined by loci for genitourinary development and genome stability

Uterine leiomyomas (ULs) are benign tumors that are a major burden to women's health. A genome-wide association study on 15,453 UL cases and 392,628 controls was performed, followed by replication of the genomic risk in six cohorts. Effects of the risk alleles were evaluated in view of molecular and clinical characteristics. 22 loci displayed a genome-wide significant association. The likely predisposition genes could be grouped to two biological processes. Genes involved in genome stability were represented by TERT, TERC, OBFC1 - highlighting the role of telomere maintenance - TP53 and ATM. Genes involved in genitourinary development, WNT4, WT1, SALL1, MED12, ESR1, GREB1, FOXO1, DMRT1 and uterine stem cell marker antigen CD44, formed another strong subgroup. The combined risk contributed by the 22 loci was associated with MED12 mutation-positive tumors. The findings link genes for uterine development and genetic stability to leiomyomagenesis, and in part explain the more frequent occurrence of UL in women of African origin.Peer reviewe

A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Aims The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported. Materials and Methods A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database. Results A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation. Conclusion A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear : a 2-year follow-up of the randomised controlled trial

Objective To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. Methods In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out. Results In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups. Conclusions In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.Peer reviewe

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: A 2-year follow-up of the randomised controlled trial

Objective: To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.Methods: In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35–65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.Results: In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, −4.3; 95% CI, −11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (−3.2; −8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (−0.4; −1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.Conclusions: In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.</p

Global metabolomic profiling of uterine leiomyomas

Background: Uterine leiomyomas can be classified into molecularly distinct subtypes according to their genetic triggers: MED12 mutations, HMGA2 upregulation, or inactivation of FH. The aim of this study was to identify metabolites and metabolic pathways that are dysregulated in different subtypes of leiomyomas. Methods: We performed global metabolomic profiling of 25 uterine leiomyomas and 17 corresponding myometrium specimens using liquid chromatography-tandem mass spectroscopy. Results: A total of 641 metabolites were detected. All leiomyomas displayed reduced homocarnosine and haeme metabolite levels. We identified a clearly distinct metabolomic profile for leiomyomas of the FH subtype, characterised by metabolic alterations in the tricarboxylic acid cycle and pentose phosphate pathways, and increased levels of multiple lipids and amino acids. Several metabolites were uniquely elevated in leiomyomas of the FH subtype, including N6-succinyladenosine and argininosuccinate, serving as potential biomarkers for FH deficiency. In contrast, leiomyomas of the MED12 subtype displayed reduced levels of vitamin A, multiple membrane lipids and amino acids, and dysregulation of vitamin C metabolism, a finding which was also compatible with gene expression data. Conclusions: The study reveals the metabolomic heterogeneity of leiomyomas and provides the requisite framework for strategies designed to target metabolic alterations promoting the growth of these prevalent tumours.Peer reviewe

Parity associates with chromosomal damage in uterine leiomyomas

Mechanical forces in a constrained cellular environment were recently established as a facilitator of chromosomal damage. Whether this could contribute to tumorigenesis is not known. Uterine leiomyomas are common neoplasms that display relatively few chromosomal aberrations. We hypothesized that if mechanical forces contribute to chromosomal damage, signs of this could be seen in uterine leiomyomas from parous women. We examined the karyotypes of 1946 tumors, and found a striking overrepresentation of chromosomal damage associated with parity. We then subjected myometrial cells to physiological forces similar to those encountered during pregnancy, and found this to cause DNA breaks and a DNA repair response. While mechanical forces acting in constrained cellular environments may thus contribute to neoplastic degeneration, and genesis of uterine leiomyoma, further studies are needed to prove possible causality of the observed association. No evidence for progression to malignancy was found. Many factors have been associated with chromosomal damage, including mechanical forces in a constrained cellular environment. Here the authors reveal an association between parity and chromosomal damage by analysing karyotypes of 1946 uterine leiomyomas.Peer reviewe