Abdominal Aortic Infections

Background. Abdominal aortic infections are dreaded disorders in vascular surgery, linked to high morbidity and mortality. Mycotic aneurysm as a primary infection of the abdominal aorta (MAAA) and an aortic graft infection (AGI) are different entities; however, due to bacterial presence in aorta and perivascular tissue, the principles of management are the same. Due to low incidence and complexity of disease, the high-quality evidence is lacking to define whether prosthetic aortic reconstructions in infectious conditions are utterly safe or whether biological reconstruction material should be preferred despite some shortcomings in durability. In complex abdominal surgery encompassing visceral aorta, prolonged aortic clamping above renal arteries is a risk factor for acute ischaemic kidney injury. In such situations, renal protection is recommended in order to avoid irreversible damage and renal replacement therapy. Aims. The aim of current study was to evaluate the infection resistance and durability of biological grafts as an aortic reconstruction material in abdominal aortic infections and to estimate the mortality after such reconstructions. Furthermore, efficacy of temporary axillo-renal bypass in prevention of renal ischaemic damage from major aortic surgery was estimated. Materials. The study comprises two parts. In the first part, 132 patients were analysed after being treated for aorto-iliac infections with arterial resection and reconstruction with a biological graft. Study I included patients treated due to AGI with femoral vein grafts, Study II included patients in whom the arterial infection was treated using cryopreserved venous allografts, and Study III included patients who were treated with various biological grafts for a primary aortic infection. The primary endpoints were postoperative mortality and reinfection rates, secondary endpoints were treatment-related mortality, overall mortality and graft reinterventions. During the second part of the study, (Study IV) patients who underwent temporary axillo-renal bypass during a major aortic intervention were retrospectively analysed. Outcome measures were postoperative kidney injury and 30-day mortality. Studies I, II and IV entailed retrospective analyses of patients treated at Helsinki University Hospital, while Study II was multicentre retrospective analysis of patients from six countries. Results. Sixty-four percent (64%, n=85) of the patients underwent surgery for an abdominal aortic infection with autologous femoral veins (FV), 17% (n=23) with cryopreserved venous allografts (CVA), 9% (n=12) with xenopericardial tube grafts, 5% (n=7) with cryopreserved arterial allografts, and 4% (n=5) with fresh arterial allografts. Most common indications for operation were aortic graft infection with an incidence of 51% (n=67) and mycotic abdominal aneurysm with 45% (n=60). The 30-day mortality was 9% for patients treated with FV for an AGI, 9% for patients treated for mixed infectious indications with cryopreserved venous allografts, and 5% for patients treated with various biological reconstructions due to MAAA,. The respective treatment-related mortality rates in these cohorts were 18%,13% and 9%. The reinfection rate was 2% (n=3) and 11% (n=14) of the grafts needed reinterventions at the mid-term follow-up, with stenotic lesions in femoral veins as the most common indication (n=9/14). Kaplan-Meier estimation of survival at 5 years was 59% (95% confidence interval, [CI] 43% – 73%) for patients treated with FV due to AGI and 71% (95% CI 52% –89%) for patients treated with mixed biological materials for MAAA. For patients treated with cryopreserved allografts for mixed indications, estimated survival at 2-years was 70% (95% CI 49% – 91%). Sixteen patients were operated with temporary axillo-renal bypass during aortic surgery. Despite short median renal ischaemia time of 24.5 minutes, 6 (38%) patients suffered acute kidney injury (AKI), of whom 4 had renal insufficiency preoperatively. One patient needed temporary renal replacement therapy, at one-month follow-up, however, renal function had returned to its baseline level or improved in all patients. The 30-day and in-hospital mortality was nil. Conclusions. Biological reconstruction material is infection resistant and reasonably durable in midterm analysis. Early postoperative and overall mortality rates are acceptable after treatment of such a complex entity as abdominal aortic infections. Furthermore, temporary axillo-renal bypass is safe and feasible in diminishing acute kidney injury during major aortic surgery.Primääri aortan infektio eli mykoottinen aneurysma ja aortan proteesi-infektio ovat vakavimpia tilanteita verisuonikirurgiassa, ja johtavat kuolemaan ilman hoitoa. Infektion parantamiseksi vierasmateriaali ja tulehtunut aorttaseinämä on pääsääntöisesti poistettava kokonaan ja raajojen verenkierto turvattava uudella verisuoniohiteella. Mikäli infektoitunut proteesi korjataan uudella proteesilla, on uusintainfektion vaara korkea. Tässä väitöskirjassa tutkitaan biologisten materiaalien toimivuutta aorttainfektioiden hoidossa sekä väliaikaisen munuaisohituksen toimivuutta akuutin munuaisen vajaatoiminnan ehkäisyssä potilailla, joilla aortta joudutaan pihdittämään munuaisvaltimon yläpuolelta korjauksen aikana. Väliaikaista ohitusta käyttämällä vältetään munuaisiskemia aorttapihdityksen aikana. Vuosina 2000-2018 tehdyistä biologisista ohituksista on kerätty seurantatiedot retrospektiivisesti HUS:ista; mykoottisten aneurysmien potilastiedot HUSin lisäksi viidestä eurooppalaisesta keskuksesta. Väliaikaisista munuaisohituksista on kerätty tiedot vuosilta 2007-2012. Tutkimuksessa arvoitiin biologisen materiaalin kestävyyttä tulehduksellisissa olosuhteissa, leikkauksenjälkeistä sairastavuutta ja pitkäaikaista eloonjäämistä. Munuaistoiminta arvioitiin ennen leikkausta ja sen jälkeen. Yhteensä tutkimusjakson aikana tehtiin yhteensä 132 biologista ohitusta aorttatulehdusten takia: rekonstruktiomateriaalina oli potilaan oma syvälaskimo 85:ssa tapauksessa, pakastettu elinluovuttajan laskimo 23:ssa tapauksessa, pakastettu elinluovuttajan valtimografti 7:ssa tapauksessa, tuore luovuttajan valtimo 5:ssa tapauksessa ja kaupallisesta härän perikardista käsin tehty tuubigrafti 12:ssa tapauksessa. Uusinta-infektioita esiintyi 2%:lla ja keskipitkän seurannan aikana 11%:lle tehtiin ohitteen korjaustoimeenpide. Ohiteen repeytymisestä johtuvia kuolemia ei ollut seuranta-aikana. Leikkauksen jälkeinen kuolleisuus oli 5%-13% kolmessa eri tutkimuksessa ja pitkäaikainen eloonjääminen 5 vuoden kohdalla 71%-59%. Leikkauksen jälkeinen munuaisten vajaatoiminta ilmaantui 6/16 potilaalle, mutta kuukauden kuluttua leikkauksesta munuaistoiminta oli palautunut lähtötasoon tai parantunut kaikissa tapauksissa. Yksikään potilas ei kuollut leikkauksen jälkeisessä vaiheessa väliaikaisen munuaisohituksen jälkeen. Tutkimuksemme mukaan biologiset ohitukset ovat infektioresistentteja ja suhteellisen kestäviä aortan korjausmateriaaleja infektio-olosuhteissa. Kuolleisuus on leikkauksen jälkeen merkittävää, mutta ottaen huomioon taudin vakavuus ja erittäin korkea mortaliteetti ilman leikkaushoitoa, kuolleisuus on hyväksyttävä sekä lyhyellä että pitkällä aikavälillä. Väliaikainen munuaisohite on tehokas tapa välttää munuaisten vajatoiminnan kehittymistä tai pahenemista haastavissa aorttaleikkauksissa

Women’s rights and heartbeats:(de)legitimation of abortion and the Texas Senate Bill 8 in the United States news media

Abstract. This thesis examines the abortion debate, which gained attention after the Texas Senate Bill 8 (SB 8) was introduced in May 2021 and came into effect on September 1st, 2021. By employing critical discourse analysis and Van Leeuwen’s (2007) framework for analyzing legitimation, this thesis aims to find out what types of discourses are prevalent in the debate and how legitimation strategies are used to justify and oppose abortion and SB 8. The reproduction of both ideologies in this debate are examined. The data for this study consist of 20 opinion articles discussing abortion and SB 8, 10 from The New York Times representing the pro-choice movement, and 10 from Fox News representing the pro-life movement. Three main discourses were identified, which appeared in both sources. These are the discourse of women and wellbeing, which frames abortion as a feminist issue, the discourse of life and personhood, which frames abortion as an issue of fetal personhood, and the discourse of legality and Constitution, which frames SB 8’s constitutionality. In addition, multiple legitimation strategies, such as impersonal authority, authority of conformity and moral evaluation, were used to achieve legitimation. The three discourses are used as a foundation for the reproduction of both pro-life and pro-choice ideologies and to seek legitimacy through legitimation strategies. Thus, abortion ideologies are reproduced through these discourses and the legitimation strategies utilized in them. Both abortion movements often seek legitimation for their arguments and ideologies by representing the other movement in a negative light. Additionally, this thesis found that women have stronger representation in The New York Times’ articles while men dominated Fox News’ articles.Naisten oikeuksia ja sydämenlyöntejä : abortin ja Texasin uuden aborttilaki SB 8:n legitimaatio ja kritisointi Yhdysvaltojen uutismediassa. Tiivistelmä. Tässä kandidaatin tutkielmassa tarkastellaan Yhdysvaltojen aborttikeskustelua, joka sai huomiota Texasin uuden aborttilain — SB 8:n — myötä. Laki esiteltiin maaliskuussa ja se astui voimaan syyskuussa 2021. Tämä tutkielma pyrkii selvittämään kriittisen diskurssianalyysin ja Van Leeuwenin (2007) legitimaation analysoinnin viitekehyksen avulla, mitä diskursseja keskustelussa esiintyy sekä millaisia legitimaatiostrategioita diskursseissa hyödynnetään. Lisäksi ideologioiden reproduktiota tarkastellaan. Tutkielman aineisto koostuu 20 mielipidekirjoituksesta, jotka ottavat kantaa aborttiin ja SB 8:aan. 10 artikkelia kerättiin The New York Times lehdestä, joka edustaa aborttimyönteistä liikettä (pro-choice), kun taas toiset 10 kerättiin Fox Newsiltä, edustaen abortinvastaista liikettä (pro-life). Kolme molemmissa lähteissä esiintyvää keskeistä diskurssia tunnistettiin. Nämä olivat: 1) naisten ja hyvinvoinnin diskurssi, joka kehystää abortin feministisenä asiana; 2) elämän ja ihmisyyden diskurssi, joka kehystää abortin sikiön ihmisyyden ongelmana, ja 3) laillisuuden ja perustuslain diskurssi, joka kehystää lain perustuslaillisuutta. Lisäksi useita legitimaatiostrategioita, kuten persoonatonta auktoriteettia, yhdenmukaisuuden auktoriteettia ja moraalista arviointia, käytetään legitimaation saavuttamiseksi. Havaittuja diskursseja käytetään pohjana molempien aborttiliikkeiden ideologioiden reproduktioon ja legitimiteetin luomiseen legitimaatiostrategioiden kautta. Täten abortti-ideologioita jäljennetään näiden diskurssien ja niissä käytettyjen legitimaatiostrategioiden kautta. Molemmat liikkeet tavoittelivat legitimaatiota argumenteillensa ja ideologioilleen usein esittämällä toisen liikkeen negatiivisessa valossa. Lisäksi tutkielmassa havaittiin, että naiset ovat enemmän esillä The New York Times lehden artikkeleissa, kun taas miehet dominoivat Fox Newsin artikkeleita

IRREGULAR WARFARE IN THE HIGH NORTH

The strategic importance of the High North––defined in this thesis as the Arctic areas of Finland, Norway, and Sweden––is increasing. Previous research on the region focuses on assessing the often-competing interests of different nations in the High North. From a military perspective, with an emphasis on irregular warfare, this study considers how an irregular warfare approach to defending against a Russian offensive in the High North might unfold. Using data collected from various sources, the study adopts a heuristic methodology. Sources credibility has been verified by thorough searches for conflicting information and differing points of view. The analysis is conducted using historical, environmental, and doctrinal data. Based on the analysis, the thesis addresses the question: What is the most effective way to deter, or if deterrence fails, to counter a Russian offensive using irregular warfare supported by conventional capabilities in the High North? As Russian offensive doctrine is best defeated by irregular approach under some circumstances, an irregular defense and counterattack can provide an effective response if Russia chooses an irregular approach. The study finds that irregular warfare conducted by small, maneuverable units provides an effective solution to the challenge of campaigning against an aggressor in the High North. The thesis recommends developing requirements for logistics, manpower, and command and control for irregular warfare in the High North.Majuri, Finnish ArmyApproved for public release. Distribution is unlimited

Mittespetsiifiline püogeenne spondüliit

Mittespetsiifiline püogeenne spondüliit on harva esinev raske haigus, mille esinemissagedus on vaid 2–7% kõikidest osteomüeliidijuhtudest (1, 2). Seoses rahvastiku vananemisega, intravenoossete narkootikumide manustamise ja epiduraalsete kateetrite kasutamisega valuravis on spondüliiti haigestumine kasvutendentsiga (3). Rootsis tehtud retrospektiivse uuringu alusel leiti haiguse esinemissageduseks 2,2 juhtu 100 000 inimese kohta aastas (4). Eesti Arst 2007; 86 (7): 485–49

Improvements to the Sink Strength Theory Used in Multi-Scale Rate Equation Simulations of Defects in Solids

The application of mean-field rate theory equations have proven to be a versatile method in simulating defect dynamics and temporal changes in the microstructure of materials. The reliability and usefulness of the method, however, depends critically on the defect interaction parameters used. In this study, we show that the main interaction parameter, the sink strength, intrinsically depends on the detrapping, or the dissociation process itself. We present a theory on how to determine the appropriate sink strengths. The correct sink strength required for a detrapping defect, is considerably larger than the values commonly used, and thus should not be neglected.Peer reviewe

Fuel inventory and material migration of JET main chamber plasma facing components compared over three operational periods

Fuel retention and material migration results from JET ITER-like wall beryllium limiter tiles are presented for three operating periods. Ion beam analysis results support the general picture of erosion during limiter configurations with local deposition on tile ends far into the scrape off layer. Similar trends of fuel concentrations are observed in all JET operating periods; (i) low on surfaces exposed to high heat flux and erosion and (ii) higher in deposits. The pattern of fuel retention and deposition correlates with heat flux and distribution of limiter plasmas touching inner and outer limiters. The D/Be ratio in the thickest deposit is similar to 0.01. Global fuel retention attributed to limiters isPeer reviewe

An interatomic potential for W-N interactions

N-2 gas is routinely used as a seeding species in fusion plasma to control the amount of power emitted from the plasma by radiation to the tungsten walls of an ITER-like divertor. Nitrogen atoms interact with the plasma-facing materials beryllium and tungsten, and form chemical bonds with the wall surfaces, as well as with plasma hydrogen isotopes, thus raising a special interest in W-N and N-H interactions in the fusion community. In this work we describe the development of an analytical interatomic potential for W-N interactions and benchmark the potential against DFT calculation results for N defects in tungsten.Peer reviewe

Consequences of hazardous dietary calcium deficiency for fattening bulls

BACKGROUND: Deficient mineral supplementation on a feedlot farm resulted in severe clinical manifestations in fattening bulls. Animals mistakenly received only 60–70% of the recommended calcium intake, while simultaneously receiving twice the amount of phosphorus recommended. Thus, the dietary Ca/P ratio was severely distorted. After approximately six months on such a diet, four fattening bulls were euthanized because of severe lameness and 15% of other animals on the farm were having clinical leg problems. Veterinary consultation revealed the mistake in mineral supplementation. METHODS: Fattening bulls were divided into three groups depending on the time of their arrival to the farm. This enabled the effect of mineral imbalance at different growth phases to be examined. After slaughtering, the bones of both front and hind limbs were macroscopically evaluated. RESULTS: Over 80% of the animals with a calcium-deficient diet had at least one severe osteoarthritic lesion. The economic impact of the calcium deficiency was statistically significant. CONCLUSION: Calcium deficiency with distorted Ca/P ratio yielded a severe outbreak of osteoarthritis in fattening bulls. Calcium deficiency caused a more serious lesions in age group 5–12 months than age group 12–18 months. Besides causing obvious economic losses osteoarthritis is also a welfare issue for feedlot animals