Recurrent Hypokalemia and Adrenal Steroids in Patients With APECED

Publisher Copyright: Copyright © 2022 Borchers, Mäkitie, Jääskeläinen and Laakso.Context: Hypokalemia is a common finding in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) but its exact cause often remains unknown. Objective: To explore the prevalence and etiology of hypokalemia and the role of adrenal steroids therein in a cohort of patients with APECED. Methods: We performed a cross-sectional assessment and retrospective data collection on 44 Finnish patients with APECED to identify subjects with episodes of hypokalemia. Also 68 healthy matched controls attended the cross-sectional evaluation. Factors associating with a tendency for hypokalemia were analyzed by reviewing medical records during 1960-2021 and performing a cross-sectional analysis of serum adrenal steroids. Results: In total 14 of the 44 APECED patients (32%) had episodes of hypokalemia; 2 presented with hypokalemia at cross-sectional evaluation and 12 had a history of hypokalemia before the cross-sectional evaluation. Hypokalemic episodes started at the median age of 14.1 years; 12/14 (86%) had primary adrenal insufficiency (PAI). The median number of hypokalemic periods per year was 0.3 (range 0.04-2.2); the frequency correlated positively with the number of clinical APECED manifestations at the time of cross-sectional evaluation (r=0.811, p<0.001). Etiologies of hypokalemia varied but episodes often occurred when new clinical manifestations developed and during hospitalizations. Three patients had kidney defects, also associated with electrolyte imbalances. Severity of hypokalemia varied (range 2.2-3.2 mmol/L), but no severe complications were observed. At cross-sectional evaluation, patients with PAI (n = 30) had significantly lower median plasma potassium and higher sodium concentration than controls, suggesting that fludrocortisone treatment contributed to hypokalemia. Detailed analysis of adrenal steroids provided no conclusive differences between patients with and without episodes of hypokalemia. Conclusions: In APECED, hypokalemia is common and varies in terms of frequency, etiology, and severity. PAI and kidney disease predispose to hypokalemia. In addition, hypokalemic periods seem to be more common in patients with more severe phenotype of APECED.Peer reviewe

Body composition and bone mineral density in children with premature adrenarche and the association of LRP5 gene polymorphisms with bone mineral density

Peer reviewe

Lääketieteen opiskelijoiden työelämälähtöinen näkemys perusopetuksen kehityskohteista : entistäkin parempia kesäkandeja

Vertaisarvioitu. English summary. Teema : kesänumero : tutkimus ja opetusLääketieteen perusopetuksen tärkeä tavoite on antaa opiskelijalle hyvät käytännön valmiudet toimia lääkärin tehtävissä. Suurin osa ylimpien vuosikurssien opiskelijoista työskentelee kesäaikana lääkärinä. Pyysimme kesätöissä olleita kahden ylimmän vuosikurssin opiskelijoita arvioimaan työelämävalmiuksiaan ja antamaan ehdotuksia perusopetuksen kehittämiseksi. Onnistumisia oli koettu ammattihenkilöstön välisen yhteistyön, potilas-lääkärivuorovaikutuksen ja potilaan haastattelemisen osa-alueilla. Heikoimmin oli onnistuttu toimenpiteissä, diagnoosin löytämisessä ja potilaan tutkimisessa. Perusopetusta toivottiin tapauslähtöisemmäksi ja enemmän perusterveydenhuollossa tarvittavaa osaamista painottavaksi. Ohjaavaa yksilöllistä palautetta ja toimenpideopetusta haluttiin lisää. Toivelistalla oli myös lausuntojen laatimisen opetusta, lääkehoidon erityiskysymysten huomiointia, moniammatillisen yhteistyön harjoittelua ja lääkäriksi kasvamisen tukemista.Peer reviewe

Characteristics and predictors of off-label use of antipsychotics in general population sample

Objective Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.Peer reviewe

National MEDigi project: systematic implementation of digitalization to undergraduate medical and dental education in Finland

MEDigi is a nationwide Finnish project that aims to develop and implement digital teaching, learning and assessment solutions and to provide possibilities for national harmonization of undergraduate medical and dental education in Finland. The MEDigi project will investigate the options and feasibility of a common national digital online platform and produce digital content and solutions for medical education. Furthermore, tools and support system for digital pedagogy training will be created to ensure that the teaching staff will achieve and retain appropriate digipedagogical skills. The project aims also to increase the competence related to the digital tools used in clinical practice (eHealth, digital health) of physicians and dentists. Furthermore, academic research will be carried out on various aspects of the project. All the universities in Finland that offer the Licentiate Degree in Medicine and Dentist programmes are involved: Universities of Eastern Finland, Helsinki, Oulu, Tampere and Turku. The project is coordinated by the University of Oulu. The project is carried out in close collaboration with the Finnish Medical Society Duodecim and the Finnish Dental Society Apollonia. The project lifespan is until the end of May 2021. MEDigi project is financed by the Finnish Ministry of Culture and Education and its total budget is over 4 million euros.</p

12. Pääsuunnittelijakoulutuksen tutkielmat

Pääsuunnittelijakoulutus on suunnittelun ja johtamisen koulutusohjelma, jonka tavoitteena on tukea pääsuunnittelutehtävissä toimivien asiantuntijoiden edellytyksiä ja valmiuksia vastata tulevaisuuden osaamisvaatimuksiin. Julkaisu sisältää 12. pääsuunnittelijakoulutuksen tutkielmat: (1) Renni Haroma: Arkkitehdin vaikutusmahdollisuudet pääsuunnittelijana KVR-urakassa; tehtävät ja vastuut, sekä onnistuneen lopputuloksen varmistaminen (2) Pontus Högström: Rakennuttajan ja pääsuunnittelijan vastuut pienrakennushankkeessa (3) Outi Jääskeläinen: Pääsuunnittelija kunnallisessa rakennusinvestointihankkeessa (4) Tuomo Kallio: Tietomalli pääsuunnittelijan työkaluna - Muuttuvat ohjeet ja määräykset (5) Sami Karvinen: Rakennesuunnittelija pääsuunnittelijana - Tehtävän erityispiirteet (6) Pauli Koivisto: Pääsuunnittelijan tehtäviä korjausrakentamiskohteissa (7) Mika Kurth: Pääsuunnittelu tietomallihankkeessa - Pääsuunnittelijan, arkkitehdin ja tietomallikoordinaattorin roolit (8) Niklas Mahlberg: Kokemuksia yhteispohjoismaisesta rakennushankkeesta - Case: Teatteri- ja konserttitalo Kilden, Kristiansand, Norja (9) Joni Räisänen: Tietomallintaminen; haasteet ja mahdollisuudet - Tietomallintaminen pääsuunnittelijavetoisessa hankkeessa - Case: Alberga Business Park (10) Sebastian Rönnblad: Pääsuunnittelu tilaajan näkökulmasta (11) Esa Sallinen: Sosiaalinen toimilupa toimitilahankkeessa - vaikutukset pääsuunnittelijan rooliin (12) Kimmo Severinkangas: Pääsuunnittelijan ja rakentamiseen ryhtyvän tehtävä- ja vastuujako vesivoimalaitoksen rakennushankkeessa - Case: Suunnitteilla oleva Sierilän vesivoimalaitoshanke (13) Erki Valdre: Pääsuunnittelun riskienhallinta - Laatujärjestelmä riskienhallintavälineenä (14) Riitta Vesala: Verkostojohtamis- ja esimiestaidot pääsuunnittelijan tehtävässä

New national and regional biological records for Finland 7. Contributions to Bryophyta and Marchantiophyta

Three species of mosses (Bryophyta: Philonotis yezoana, Protobryum bryoides, Rhynchostegium murale) and one of liverworts (Marchantiophyta: Moerckia flotoviana) are presented new for Finland. Timmia megapolitana, previously thought to be regionally extinct, is reported to being found again. New records in biogeographical provinces for 82 species of mosses and 34 species of liverworts are listed. Finally, 8 occurrences in provinces are removed due to misidentifications or missing specimens

Human gut-commensalic Lactobacillus ruminis ATCC 25644 displays sortase-assembled surface piliation: Phenotypic characterization of its fimbrial operon through in silico predictive analysis and recombinant expression in Lactococcus lactis

Sortase-dependent surface pili (or fimbriae) in Gram-positive bacteria are well documented as a key virulence factor for certain harmful opportunistic pathogens. However, it is only recently known that these multi-subunit protein appendages are also belonging to the "friendly" commensals and now, with this new perspective, they have come to be categorized as a niche-adaptation factor as well. In this regard, it was shown earlier that sortase-assembled piliation is a native fixture of two human intestinal commensalics (i.e., Lactobacillus rhamnosus and Bifidobacterium bifidum), and correspondingly where the pili involved have a significant role in cellular adhesion and immunomodulation processes. We now reveal that intestinal indigenous (or autochthonous) Lactobacillus ruminis is another surface-piliated commensal lactobacillar species. Heeding to in silico expectations, the predicted loci for the LrpCBA-called pili are organized tandemly in the L. ruminis genome as a canonical fimbrial operon, which then encodes for three pilin-proteins and a single C-type sortase enzyme. Through electron microscopic means, we showed that these pilus formations are a surface assemblage of tip, basal, and backbone pilin subunits (respectively named LrpC, LrpB, and LrpA) in L. ruminis, and also when expressed recombinantly in Lactococcus lactis. As well, by using the recombinant-piliated lactococci, we could define certain ecologically relevant phenotypic traits, such as the ability to adhere to extracellular matrix proteins and gut epithelial cells, but also to effectuate an induced dampening on Toll-like receptor 2 signaling and interleukin-8 responsiveness in immune-related cells. Within the context of the intestinal microcosm, by wielding such niche-advantageous cell-surface properties the LrpCBA pilus would undoubtedly have a requisite functional role in the colonization dynamics of L. ruminis indigeneity. Our study provides only the second description of a native-piliated Lactobacillus species, but at the same time also involves the structural and functional characterization of a third type of lactobacillar pilus.Peer reviewe

New national and regional biological records for Finland 7. Contributions to Bryophyta and Marchantiophyta

Three species of mosses (Bryophyta: Philonotis yezoana, Protobryum bryoides, Rhynchostegiummurale) and one of liverworts (Marchantiophyta: Moerckia flotoviana) are presented new for Finland.Timmia megapolitana, previously thought to be regionally extinct, is reported to being foundagain. New records in biogeographical provinces for 82 species of mosses and 34 species of liverwortsare listed. Finally, 8 occurrences in provinces are removed due to misidentifications ormissing specimens.</p

Effect of small-scale snow surface roughness on snow albedo and reflectance

The primary goal of this paper is to present a model of snow surface albedo accounting for small-scale surface roughness effects. The model is based on photon recollision probability, and it can be combined with existing bulk volume albedo models, such as Two-streAm Radiative Trans-fEr in Snow (TARTES). The model is fed with in situ measurements of surface roughness from plate profile and laser scanner data, and it is evaluated by comparing the computed albedos with observations. It provides closer results to empirical values than volume-scattering-based albedo simulations alone. The impact of surface roughness on albedo increases with the progress of the melting season and is larger for larger solar zenith angles. In absolute terms, small-scale surface roughness can decrease the total albedo by up to about 0.1. As regards the bidirectional reflectance factor (BRF), it is found that surface roughness increases backward scattering especially for large solar zenith angle values