Caudal Fgfr1 disruption produces localised spinal mis-patterning and a terminal myelocystocele-like phenotype in mice

Closed spinal dysraphisms are poorly understood malformations classified as neural tube (NT) defects. Several, including terminal myelocystocele, affect the low spine. We previously identified a NT closure-initiating point, Closure 5, in the distal spine of mice. Here we document equivalent morphology of the caudal-most closing posterior neuropore (PNP) in mice and humans. Closure 5 forms in a region of active FGF signalling and pharmacological FGF receptor blockade impairs its formation in cultured mouse embryos. Conditional genetic deletion of Fgfr1 in caudal embryonic tissues with Cdx2Cre diminishes neuroepithelial proliferation, impairs Closure 5 formation and delays PNP closure. After closure, the distal NT of Fgfr1-disrupted embryos dilates to form a fluid-filled sac overlying ventrally flattened spinal cord. This phenotype resembles terminal myelocystocele. Histological analysis reveals regional and progressive loss of SHH and FOXA2-positive ventral NT domains, resulting in OLIG2-labelling of the ventral-most NT. The OLIG2-domain is also subsequently lost, eventually producing a NT entirely positive for the dorsal marker PAX3. Thus, a terminal myelocystocele-like phenotype can arise after completion of NT closure with localised spinal mis-patterning caused by disruption of FGFR1 signalling

Hoitohenkilökunnan tietämys painehaavoista ja niiden ennaltaehkäisystä : tietotestin analysointi

Tämän opinnäytetyön tarkoituksena oli selvittää hoitohenkilökunnan tietoa ja osaamista painehaavoista, ennaltaehkäisystä, hoidosta sekä painehaavan riskipotilaiden tunnistamisessa. Yhteistyökumppaneina opinnäytetyössä olivat Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) Medisiininen tulosyksikkö sekä Metropolia ammattikorkeakoulu, Terveys- ja hoitoala. Tavoitteena oli tuottaa tietoa hoitotyötekijöiden osaamisesta riskipotilaiden tunnistamisessa sekä painehaavan ennaltaehkäisyssä Opinnäytetyössä käytettiin määrällistä tutkimusmenetelmää. Tutkimukseen osallistui perusterveydenhuollon yksiköt ja erikoissairaanhoidon yksiköt. Aineisto kerättiin tietotestin avulla. Tietotesti perustuu Barbara Bierin laatimaa mittariin joka on muokattu HUS:n tietotestiin sopivaksi. Kysely lähetettiin sähköisenä ja osa paperisena versiona. Vastaukset analysointiin Digium Enterprisen Questback ohjelmalla. Tietotestin tulosten perusteella erikoissairaanhoidon ja perusterveydenhuollon painehaa-vaumien ennaltaehkäisyn tietämyksen vahvimpina nousi esille oikeanlaisen painetta vähentävän patjan valitseminen niille potilaille jotka ovat painehaava alttiita. Hoitajien painehaavojen toiseen asteen luokittelun tunnistaminen oli puutteellista. Tietämys tuolissa istuvan potilaan asennon muuttaminen tiheämmin oli heikkoa ja Braden riskimittarin vastauksen tulkitseminen oli hyvin puutteellista. Tuloksissa selvisi myös, että suurin osa hoitajista ei ollut tietoisia Suomen haavanhoitoyhdistyksen kääntämän EPUAP painehaavan ehkäisyn pikaoppaasta. Braden toimii riskiluokituksen mittarina hoitotyön apuvälineenä, jotta siitä olisi hyötyä kaikki hoitajat täytyisi kouluttaa riskiluokituksen käyttämisessä. Hoitohenkilökunnalle täytyy tuoda enemmän tietoa uusista tutkituista tiedoista käytännön työhön.The purpose of our thesis was to sort out knowledge and skills of the nursing staff in preventing, treating and recognizing the patients who are at risk of pressure ulcers. The partners of this thesis were Helsinki and Uusimaa (HUS) Medical & Technology digit profit center and the Helsinki Metropolia University of Applied Sciences, Health & Social care. The aim of this thesis was to provide and gain information about the nursing staff skills’ of identifying risk patients and preventing pressure ulcers. Quantative research method was used in this thesis. Primary health care units and specialized units participated in this research and the data was collected by test data method. Test data is based on information prepared by Barbara Bier meter which is then modified to fit the test data of HUS. Inquiry was sent in electronic format and rest was hard copy versions. The results were analyzed by Digium Enterprisen Questback program. Based on the results of test data, the strongest knowledge of specialized and primary health care was the right type of selection of mattresses that reduce the pressures from those patients who were susceptible to pressure ulcer. Nurse`s understanding on secondary level classification of pressure ulcers’ identification was inadequate. The knowledge of changing the position more frequent of a patient who was sitting in a chair was weak and interpretations of answers by Braden risk indicator was very poor. The results revealed that the majority of the nurses were not much aware of Finish Wound Management Association EPUAP pressure ulcer prevention quick start guide. Braden works as a measure of risk rating tool. In order to be useful tool, all nurses should be trained to use it as a risk indicator. Medical staff needs to be given more information about new researches in the practical work area

Major cardiovascular events and associated factors among routine hemodialysis patients with end-stage renal disease at tertiary care hospital in Somalia

IntroductionCardiovascular complications are the most significant cause of death in patients undergoing routine hemodialysi (HD) with end-stage renal disease (ESRD). The main objective of this study is to determine the significant cardiac events and risk factors in patients undergoing routine hemodialysis in Somalia.MethodsWe carried out a cross-sectional retrospective study in a single dialysis center in Somalia. Two hundred out of 224 were included. All of them had ESRD and were on hemodialysis during the study period between May and October 2021. The records of all patients were reviewed, and the following parameters were analyzed socio-demographic factors, risk factors for cardiovascular disease, and the presence of cardiovascular diseases.ResultsThe mean age was 54 ± 17.5 years (range 18–88 years), and 106 (53%) patients were males. The prevalence of a cardiovascular disease among hemodialysis patients was 29.5%. Moreover, the distribution of cardiovascular diseases was different; heart failure was the most common, about 27.1%, followed by coronary artery disease (17%), pericarditis and pericardial-effusion (13.6%), dysrhythmia (10.2%), cerebrovascular-accident (8.5%), and peripheral vascular disease (3.4%). About 176 (88%) participants had at least one modifiable cardiovascular risk factor. The most common modifiable cardiovascular risk factor was hypertension (n = 45, 25.1%), followed by anemia (n = 28, 15.6%) and diabetes (n = 26, 14.5%). Younger (18–30) participants were six times less likely to have cardiovascular events among hemodialysis than older age 0.4 (0.11–1.12).ConclusionLow prevalence rate of cardiovascular complications was confirmed in ESRD patients receiving hemodialysis in the main HD center in Somalia. Diabetes, anemia, and hypertension were the highest significant risk factors for CVD in HD patients with ESRD in Somalia