Dendroclimatic transfer functions revisited : Little Ice Age and Medieval Warm Period summer temperatures reconstructed using artificial neural networks and linear algorithms

Peer reviewe

Quality of life and metabolic status in mildly depressed women with type 2 diabetes treated with paroxetine: A single-blind randomised placebo controlled trial

BACKGROUND: Depression is prevalent in people with type 2 diabetes and affects both glycemic control and overall quality of life. The aim of this trial was to evaluate the effect of the antidepressant paroxetine on metabolic control, quality of life and mental well-being in mildly depressed women with type 2 diabetes. METHODS: We randomised 15 mildly depressed women with non-optimally controlled type 2 diabetes to a 10-week single-blind treatment with either paroxetine 20 mg per day or placebo. Primary efficacy measurements were glycemic control and quality of life. Glycosylated hemoglobin A(1c )(GHbA(1c)) was used as a measure of glycemic control. Quality of life was evaluated using RAND-36. Mental state was assessed using two clinician-rated scoring instruments, Hamilton's Anxiety Scale (HAM-A) and Montgomery-Åsberg's Depression Rating Scale (MADRS), and a patient-rated scoring instrument, Beck's Depression Inventory (BDI). RESULTS: At the end of the study no significant difference between groups in improvement of quality of life was found. A trend towards a superior improvement in glycemic control was found in the paroxetine group (p = 0.08). A superior increase in sex-hormone-binding-globuline (SHBG) levels was evidenced in the paroxetine group (p = 0.01) as a sign of improved insulin sensitivity. There was also a trend for superior efficacy of paroxetine in investigator-rated anxiety and depression. This notion was supported by a trend for superior decrease of serum cortisol levels in the paroxetine group (p = 0.06). CONCLUSION: Paroxetine has a beneficial effect on measures of insulin sensitivity and may improve glycemic control. Larger studies of longer duration are needed to verify the benefits of paroxetine in type 2 diabetes. While waiting for more conclusive evidence it seems sensible to augment standard care of type 2 diabetes with paroxetine even in patients who do not fulfil routine psychiatric criteria for initiation of antidepressant drug treatment

Clinical practice selectively follows acute appendicitis guidelines

Peer reviewe

Redox-switch regulatory mechanism of thiolase from Clostridium acetobutylicum

Thiolase is the first enzyme catalysing the condensation of two acetyl-coenzyme A (CoA) molecules to form acetoacetyl-CoA in a dedicated pathway towards the biosynthesis of n-butanol, an important solvent and biofuel. Here we elucidate the crystal structure of Clostridium acetobutylicum thiolase (CaTHL) in its reduced/oxidized states. CaTHL, unlike those from other aerobic bacteria such as Escherichia coli and Zoogloea ramegera, is regulated by the redox-switch modulation through reversible disulfide bond formation between two catalytic cysteine residues, Cys88 and Cys378. When CaTHL is overexpressed in wild-type C. acetobutylicum, butanol production is reduced due to the disturbance of acidogenic to solventogenic shift. The CaTHLV77Q/N153Y/A286K mutant, which is not able to form disulfide bonds, exhibits higher activity than wild-type CaTHL, and enhances butanol production upon overexpression. On the basis of these results, we suggest that CaTHL functions as a key enzyme in the regulation of the main metabolism of C. acetobutylicum through a redox-switch regulatory mechanism.close0

A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol

Introduction Recent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking.Methods and analysis The APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18–60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher’s one-sided test and CI will be calculated for proportion difference.Ethics and dissemination This protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals.</div

Sää- ja ilmastoriskit Suomessa - Kansallinen arvio

Tähän raporttiin on koottu ajantasainen arvio sään ja ilmaston aiheuttamista riskeistä eri toimialoille Suomessa. Arviossa otettiin huomioon sekä muuttuvan ilmaston että yhteiskunnallisen kehityksen vaikutus riskin muodostumiseen nykyhetkessä ja tulevaisuudessa. Sää- ja ilmastoriskejä pyrittiin hahmottamaan vaaratekijän (riskiä aiheuttava sääilmiö), altistumisen (riskin kohteen sijainti) ja haavoittuvuuden (riskin kohteen ominaisuudet) yhdistelmänä. Sääilmiöt aiheuttavat Suomessa riskejä jo nykyilmastossa. Muun muassa rajuilmat, helleaallot ja rankkasateet aiheuttavat taloudellisia ja terveydellisiä vaikutuksia sekä yleistä haittaa. Tulevaisuudessa riskit muuttuvat ilmastonmuutoksen muuttaessa haitallisia sääilmiöitä. Ilmastonmuutos tuo vähitellen kasvavia riskejä erityisesti ekosysteemeille ja infrastruktuurille. Muualla maailmalla tapahtuvat ilmastonmuutoksen vaikutukset voivat heijastua epäsuorasti Suomeen globaalien tavara-, energia-, raha- ja ihmisvirtojen kautta. Näiden riskien systemaattinen arviointi on vasta aloitettu. Raportin tavoitteena on tukea yhteiskunnan riskeihin varautumista ja ilmastonmuutokseen sopeutumista eri hallinnon tasoilla ja toimialoilla. Arvio perustuu pääosin kirjallisuudesta löytyviin tutkimuksiin ja selvityksiin sekä asiantuntija-arvioihin. Työ tehtiin “Sää- ja ilmastoriskien arviointi ja toimintamallit” (SIETO)- hankkeessa vuosina 2017–2018

Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Background No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. Methods This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987-2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. Results A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82-1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72-1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45-1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996-2016 mirrored the main analysis. Conclusions This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.</p

Moving Beyond Mimicry: Developing Hybrid Spaces in Indian Business Schools

This article analyses the identity work of Indian management educators and scholars as they seek to establish, maintain and revise a sense of self in the context of business school globalization. We show how globalization, combined with the historical legacy of colonialism, renders Indian scholars precarious in their interactions with Western business schools. Based on a qualitative interview study, we explore how Indian business school scholars perform their identities in the context of neo-colonial relations, which are characterised by the dominance of English language and a pressure to conform to research norms set by globally-ranked journals. Drawing on postcolonial theory, our argument focuses on mimicry as a distinctive form of identity work that involves maintaining difference between Western and non-Western identities by 'Othering' Indian scholars, while simultaneously seeking to transform them. We draw attention to ambivalence within participants' accounts, which we suggest arises because the authority of Western scholarship relies on maintaining non-Western scholars in a position of alterity or 'not quite-ness'. We suggest that hybridity offers an opportunity to disrupt and question current practices of business school globalization and facilitate scholarly engagement that reflects more diverse philosophical positions and worldviews