Ulkomaisten väliyhteisöjen verotuksesta Suomessa ja väliyhtiölain tulkintaongelmista

Siirretty Doriast

Fluoroquinolone antibiotic users select fluoroquinolone-resistant ESBL-producing Enterobacteriaceae (ESBL-PE) - Data of a prospective traveller study

Background: One third of travellers to the poor regions of the (sub) tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-betalactam antibiotics complicates the treatment of potential ESBL-PE infections. Methods: We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub) tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. Results: Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. Conlusions: While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate. (C) 2017 The Author(s). Published by Elsevier Ltd.Peer reviewe

Enabling and promoting walking rehabilitation by paired associative stimulation after incomplete paraplegia : a case report

Introduction: Paired associative stimulation (PAS) is a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) and induces plastic changes in the human corticospinal tract. We have previously shown that PAS consisting of TMS pulses given at 100% of stimulator output and high-frequency PNS is beneficial for motor rehabilitation of patients with a chronic incomplete spinal cord injury (SCI). The therapeutic possibilities of this PAS variant for walking rehabilitation of paraplegic patients are unexplored. Case presentation: A 47-year old man with traumatic incomplete paraplegia (AIS D, neurological level T7) received PAS to his left leg for 3 months at 12 months post injury (PAS1) and for an additional 3 months at 24 months post injury (PAS2). The right leg had normal AIS scores and was not stimulated. Before PAS, the patient was nonambulatory, could not stand without weight support, and was consequently not eligible for conventional walking rehabilitation. After PAS1, the patient could stand for 1.5 min and take 13 steps (24 steps in follow up) on parallel bars without weight support and was enrolled into conventional walking rehabilitation. He achieved independent walking ability with a rollator. During PAS2, walking distance increased 2.4 times faster than during the preceding year. The left leg AIS score and spinal cord independence measure mobility subscore increased. No adverse effects were detected. Discussion: This is the first report of PAS with a high-frequency peripheral component that enabled and promoted walking rehabilitation. Together with previous reports on this technique, this result encourages further research into its therapeutic potential and mechanism. © 2020, The Author(s).Peer reviewe

Vaakaerotussäiliöiden suunnitteluperusteiden tarkastelu laskennallisen virtausdynamiikan avulla

Horizontal phase separator units are commonly used in the process engineering. The horizontal phase separators are based on the gravity; external force is not used to boost the separation. In the process industry, the separation of multiphase fluids is important to protect the other process equipment (e.g. pumps and compressors). Mixtures between immiscible multiphase fluids are usually found from the turbulent processes, where flow velocities are high. Gravitational separators are used to provide low enough velocities to separate these immiscible liquid-liquid or gas-liquid mixtures. The design of the gravitational phase separators is usually based on the design engineer's know-how and simple empiric correlations. Computational fluid dynamics (CFD) offer tools to model different geometries and perform more extensive study to the flow phenomena. This gives the opportunity to simulate and evaluate the behaviour of different geometries and vessel orientations. In the literature part of this thesis the phenomena affecting to the gravitational separation is reviewed. In addition, the most important design parameters are presented. Furthermore, the CFD modelling of separation process is discussed, and a few example cases from the literature are reviewed. In the experimental part of this thesis two-phase gas-liquid separation is studied by CFD. Effect of several parameters, like the compression term, liquid droplet size, and the effect of turbulence model used were analysed. Additionally, several inlet distributer geometries were studied and analysed. The used model was found out to be sensitive for the studied parameters. Especially droplet size was found out to affect drastically to the results. When effect of different inlet distributers were studied, it was found out that the curved pipe distributers perform better than the impact plates. In addition, a small comparison between the single phase and two-phase model was performed. The similarities in flow patterns indicated that single phase modelling could provide accurate enough data to help compare designs. However, this is problem dependent and requires further studies.Vaakaerotussäiliöitä käytetään laajalti painovoimaiseen faasierotutukseen prosessiteollisuudessa. Painovoimaisessa faasierotuksessa faasien erottamiseen ei käytetä ulkoista voimaa, vaan erotus tapahtuu säiliössä painovoiman avulla. Faasierotus on prosessiteollisuudessa erityisen tärkeää, sillä useampaa faasia sisältävät virtaukset saattavat aiheuttaa ongelmia muussa laitteistoissa (esim. pumput). Monifaasivirtauksia esiintyy erityisesti kovissa nopeuksissa ja turbulenteissa olosuhteissa, jolloin toisiinsa liukenemattomien faasien sekoittuminen mahdollistuu. Vaakaerotussäiliöiden suunnittelu perustuu usein suunnittelijan kokemukseen ja yksinkertaisiin empiirisiin korrelaatioihin. Laskennallinen virtausdynamiikka (CFD) tarjoaa työkalut mallintaa ja simuloida virtauksia esimerkiksi erilaisten syötönjakajien tai säiliögeometrioiden kanssa. Tämä tarjoaa suunnittelijalle lisää tietoa mahdollisesta virtauskäyttäytymisestä ja ongelmakohdista. Tämän työn kirjallisuusosassa käsitellään vaakaerotukseen liittyviä ilmiöitä sekä suunnitteluperusteita. Lisäksi esitellään CFD laskennan kaksifaasimallinnusperusteita ja kirjallisuudesta löytyneitä neste-neste erotustapauksia. Työn soveltavassa osassa esitellään työssä simulointiin käytetty CFD kaksifaasimalli, esitellään tutkittu tapaus ja simuloinnit. Työssä tutkittiin erilaisten malliparametrien (kuten turbulenssimallin ja nesteen pisarakoon) vaikutusta. Havaittiin, että käytetty kaksifaasimalli oli erittäin herkkä ja jo pienet malliasettelun muutokset johtivat suhteellisen isoihin muutoksiin tuloksissa. Lisäksi tutkittiin erilaisten syötönjakajien vaikutusta erotustehokkuuteen. Käyräputkien havaittiin parantavan erotustehokkuutta enemmän kuin törmäyslevyjen. Kuitenkin kaikki testatut syötönjakajat paransivat erotusta. Lisäksi havaittiin yksifaasimallinnuksen ennustavan kaasuvirtauksen käyttäytymistä hyvin. Tulevissa tutkimuksissa onkin tärkeää havainnoida voidaanko ongelmaa mallintaa yksinkertaisemman ja helppokäyttöisemmän yksifaasimallinnuksen kautta ja tuoko monifaasimallinnus tarvittavaa lisäarvoa ongelmanratkaisuun. Mallin valinta on kuitenkin aina ongelmasidonnainen ja vaatii ymmärrystä sekä olemassa olevista työkaluista, että mallinnettavasta ongelmasta

Travellers' diarrhoea : Impact of TD definition and control group design on study results

AbstractBackground Travellers' diarrhoea (TD) is a common health problem among visitors to the (sub)tropics. Much research deals with aetiology, prevention, and post-infection sequalae, yet the data may not allow comparisons due to incompatible definitions of TD and No TD control groups. Method The impact of defining TD and No TD control groups was explored by revisiting our recent data. We set up two TD groups: classical TD i.e. ≥3 loose or liquid stools/day and WHO TD (diarrhoea as defined by the WHO) i.e. any diarrhoea, and four No TD groups by TD definition and timing (no classical/WHO TD during travel, no ongoing classical/WHO TD). Results TD was recorded for 37% versus 65% of subjects when using classical versus WHO definitions, respectively; the proportions of the various pathogens proved similar. The strictest criterion for the No TD control group (no WHO TD during travel) yielded pathogens among 61% and the least strict (no ongoing classical TD) among 73% of the travellers; the differences were greatest for enteroaggregative Escherichia coli and Campylobacter. Conclusions Definition of TD and control group design substantially impact on TD study results. The WHO definition yields more cases, but the pathogen selection is similar by both definitions. Design of the No TD control group was found critical: only those remaining asymptomatic throughout the journey should be included.Peer reviewe

A simple magnetoencephalographic auditory paradigm may aid in confirming left-hemispheric language dominance in epilepsy patients

Objective The intracarotid amobarbital procedure (IAP) is the current "gold standard" in the preoperative assessment of language lateralization in epilepsy surgery candidates. It is, however, invasive and has several limitations. Here we tested a simple noninvasive language lateralization test performed with magnetoencephalography (MEG). Methods We recorded auditory MEG responses to pairs of vowels and pure tones in 16 epilepsy surgery candidates who had undergone IAP. For each individual, we selected the pair of planar gradiometer sensors with the strongest N100m response to vowels in each hemisphere and -from the vector sum of signals of this gradiometer pair-calculated the vowel/tone amplitude ratio in the left (L) and right (R) hemisphere and, subsequently, the laterality index: LI = (L-R)/(L+R). In addition to the analysis using a single sensor pair, an alternative analysis was performed using averaged responses over 18 temporal sensor pairs in both hemispheres. Results The laterality index did not correlate significantly with the lateralization data obtained from the IAP. However, an MEG pattern of stronger responses to vowels than tones in the left hemisphere and stronger responses to tones than vowels in the right hemisphere was associated with left-hemispheric language dominance in the IAP in all the six patients who showed this pattern. This results in a specificity of 100% and a sensitivity of 67% of this MEG pattern in predicting left-hemispheric language dominance (p = 0.01, Fisher's exact test). In the analysis using averaged responses over temporal channels, one additional patient who was left-dominant in IAP showed this particular MEG pattern, increasing the sensitivity to 78% (p = 0.003). Significance This simple MEG paradigm shows promise in feasibly and noninvasively confirming left-hemispheric language dominance in epilepsy surgery candidates. It may aid in reducing the need for the IAP, if the results are confirmed in larger patient samples.Peer reviewe

Evaluation of High-Throughput PCR and Microarray-Based Assay in Conjunction with Automated DNA Extraction Instruments for Diagnosis of Sepsis

BACKGROUND: High incidence of septic patients increases the pressure of faster and more reliable bacterial identification methods to adapt patient management towards focused and effective treatment options. The aim of this study was to assess two automated DNA extraction solutions with the PCR and microarray-based assay to enable rapid and reliable detection and speciation of causative agents in the diagnosis of sepsis. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated two automated DNA instruments NucliSENS® easyMAG® and NorDiag Arrow for the preparation of blood culture samples. A set of 91 samples flagged as positive during incubation was analyzed prospectively with the high-throughput generation of Prove-it™ Sepsis assay designed to identify over 60 gram-negative and gram-positive bacterial species as well as methicillin resistance marker from a blood culture. Bacterial findings were accurately reported from 77 blood culture samples, whereas 14 samples were reported as negative, containing bacteria not belonging to the pathogen panel of the assay. No difference was observed between the performance of NorDiag Arrow or NucliSENS® easyMAG® with regard to the result reporting of Prove-it™ Sepsis. In addition, we also assessed the quality and quantity of DNA extracted from the clinical Escherichia coli isolate with DNA extraction instruments. We observed only minor differences between the two instruments. CONCLUSIONS: Use of automated and standardized sample preparation methods together with rapid, multiplex pathogen detection offers a strategy to speed up reliably the diagnostics of septic patients. Both tested DNA extraction devices were shown to be feasible for blood culture samples and the Prove-it™ Sepsis assay, providing an accurate identification of pathogen within 4.5 hours when the detected pathogen was in the repertoire of the test

Optimal peripheral nerve stimulation intensity for paired associative stimulation with high-frequency peripheral component in healthy subjects

Publisher Copyright: © 2022, The Author(s).Paired associative stimulation (PAS) with high-frequency peripheral nerve stimulation (PNS), called “high-PAS”, induces motor-evoked potential (MEP) potentiation in healthy subjects and improves muscle activity and independence in incomplete spinal cord injury patients. Data on optimal PNS intensity in PAS are scarce. In a high-PAS protocol, PNS intensity is defined as “minimal intensity required to produce F-responses”. We sought to further refine this definition and to investigate how PNS intensity affects PAS outcome. Two experiments were performed on 10 healthy subjects where MEP amplitude change was measured 0, 30, and 60 min after PAS. In the first experiment, the intensity required to achieve 7/10 persistence of F-responses was used to define PNS intensity level. In the second experiment, we used the intensity required to achieve 1/10 persistence (“baseline”). In addition, we applied this intensity at + 25%, − 25%, and − 50% levels. In the first experiment, PAS did not produce significant MEP potentiation. In the second experiment, PAS produced statistically significant MEP potentiation, with PNS intensity of “baseline” and “baseline − 25%” levels but not at + 25% or − 50% levels. In conclusion, for PAS utilizing high-frequency PNS, the intensity required to achieve 1/10 F-response persistence or the intensity 25% lower produces significant MEP potentiation in healthy subjects.Peer reviewe

Despite antibiotic treatment of travellers' diarrhoea pathogens are found in stools from half of travellers at return

Background: Among visitors to the (sub)tropics, 20-50% contract travellers' diarrhoea (TD) and 5-30% take antibiotics. While shortening the duration of illness, antimicrobials predispose to acquisition of multi-drug resistant bacteria. Therefore, liberal use is no longer advocated. Although antibiotics kill pathogens, no data support the view that they could prevent post-infectious sequelae. We investigated how antibiotic use for TD abroad impacts the pathogen findings at return. Materials and methods: We revisited 456 travellers' clinical data and stool pathogens examined by qPCR for Salmonella, Yersinia, Campylobacter, Shigella, Vibrio cholerae and enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC) and enteroinvasive (EIEC) Escherichia coli. Results: Among travellers with TD, antibiotic users had pathogen-positive samples less frequently than non-users (50% versus 83%). The difference was significant for EPEC (23% versus 47%) and EAEC (27% versus 54%), but not ETEC (17% versus 26%) or the other pathogens. Shigella/EIEC was found more often among antibiotic users than non-users (4% versus 1%). Conclusion: Despite antibiotic treatment of TD, half of the users still had stool pathogens at return, reflecting either antibiotic resistance of pathogens or recolonisation/reinfection while abroad. Treatment of TD with antibiotics during travel should not be interpreted to indicate eradication of pathogens.Peer reviewe

A prospective study of travellers' diarrhoea : analysis of pathogen findings by destination in various (sub)tropical regions

Objectives: Eighty million travellers visiting (sub)tropical regions contract travellers' diarrhoea (TD) each year, yet prospective data comparing the prevalence of TD pathogens in various geographical regions are scarce. Our recent study using modern molecular methods found enteropathogenic (EPEC) and enteroaggregative (EAEC) Escherichia coli to be the most frequent pathogens, followed by enterotoxigenic E. coli (ETEC) and Campylobacter. We revisited our data to compare the findings by geographical region. Methods: A total of 459 prospectively recruited travellers provided stool samples and completed questionnaires before and after visiting destinations in various geographical regions. A multiplex quantitative real-time PCR assay was used to analyse Salmonella, Yersinia, Campylobacter jejuni/Campylobacter coli, Shigella, Vibrio cholerae, EPEC, EAEC, ETEC, enterohaemorrhagic E. coli and enteroinvasive E. coli. Results: TD was contracted by 69% (316/459) of the subjects; EPEC and EAEC outnumbered ETEC and Campylobacter in all regions. Multiple pathogens were detected in 42% (133/316) of the samples. The proportions of all pathogens varied by region. The greatest differences were seen for Campylobacter: while relatively frequent in South Asia (n = 11; 20% of the 55 with TD during travel) and Southeast Asia (15/84, 15%), it was less common in East and West Africa (5/71, 7% and 1/57, 2%) and absent in South America and the Caribbean (0/40). Conclusions: EPEC and EAEC outnumbered ETEC and Campylobacter everywhere, yet the proportions of pathogen findings varied by region, with ETEC and Campylobacter rates showing the greatest differences. The high frequency of multibacterial findings in many regions indicates a need for further investigation of the clinical role of each pathogen. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.Peer reviewe