Luokanopettajien käsityksiä arvokasvatuksesta koulussa

Pro gradu -tutkielman tavoitteena on selvittää, millaisia käsityksiä luokanopettajilla on arvokasvattajana toimimisesta. Tutkielmassa kysytään, millaisia arvoja luokanopettajat oppilaille välittävät ja millainen on niiden suhde opettajien henkilökohtaisiin arvoihin. Lisäksi tarkastellaan opettajien työssään kokemia arvoristiriitoja sekä sitä, miten arvokasvatus koulussa käytännössä toteutuu. Tutkielmaa varten on haastateltu neljää luokanopettajaa. Laadullisiin tutkimusmenetelmiin perustuvassa tutkielmassa sovelletaan fenomenografista metodia. Tutkimustulosten perusteella koulun arvokasvatuksen taustalla ovat yleismaalliset perusarvot, jotka vaikuttavat kaikkeen koulun toimintaan. Lisäksi on olemassa yleisesti jaettuja arvoja, joiden välittämistä opettajat pitävät tärkeinä, sekä arjessa konkreettisesti välittyviä arvoja, joita välitetään koulussa usein tiedostamattomasti. Välitettävät arvot perustuvat pääasiassa opetussuunnitelmaan, mutta myös opettajien henkilökohtaiset arvot vaikuttavat esimerkiksi siihen, kuinka arvoja painotetaan. Opettajat kokevat työssäjaksamisen kannalta tärkeäksi, että heidän arvonsa ovat pääasiassa samanlaisia kuin koulun arvot. Erilaiset arvot johtavat ajoittain perheiden ja koulun välisiin ristiriitoihin, joiden ehkäisemisen ja ratkaisemisen kannalta olennaista on kunnioittava suhtautuminen ihmisiin riippumatta heidän arvoistaan. Tehdystä fenomenografisesta analyysistä voidaan päätellä, että arvokasvatuksen merkitys on viime vuosina kasvanut, kun oppilaiden kotoaan saama arvopohja on heikentynyt. Arvojen välittämisen ohella oppilaita on tärkeää ohjata pohtimaan ja kehittämään omaa arvomaailmaansa. Arvokasvatus on olennainen osa kaikkea koulun päivittäistä arkea, ja lisäksi yksittäisiä arvoja voidaan painottaa tiedostetusti esimerkiksi viikon tai koko lukuvuoden ajan. Usein arvokasvatus on tiedostamatonta, vaikka opettajat pyrkivät tekemään siitä tietoista esimerkiksi oman toiminnan reflektoinnin tai kollegoiden kanssa käytävien keskustelujen avulla

Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments

Objectives: Static mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient's daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246-56). Methods: We studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test. Results: SMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance. Conclusions: SMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization. Implications: SMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.Peer reviewe

Optimal Perioperative Fluid Therapy Associates with Fewer Complications After Pancreaticoduodenectomy

Background Optimal fluid management in pancreaticoduodenectomy patients remains contested. We aimed to examine the association between perioperative fluid administration and postoperative complications. Methods We studied 168 pancreaticoduodenectomy patients operated in 2015 (n = 93) or 2017 (n = 75) at Helsinki University Hospital. In 2015, patients received intraoperative fluids following a goal-directed approach and, in 2017, according to anesthesiologist's clinical practice (conventional fluid management). We analyzed the differences in perioperative fluid administration between the groups, specifically examining the occurrence of severe complications (Clavien-Dindo >= III), pancreatic fistulas, cardiovascular complications, and the length of hospital stay. Results The goal-directed group received more intraoperative fluids than the conventional fluid management group (12.0 ml/kg/h vs. 8.3 ml/kg/h, p < 0.001). Urine output (770 ml vs. 575 ml, p = 0.004) and intraoperative fluid balance (9.4 ml/kg/h vs. 6.3 ml/kg/h, p < 0.001) were higher in the goal-directed group than in the conventional fluid management group. Severe surgical complications (19.4% vs. 38.7%, p = 0.009) as well as clinically relevant pancreatic fistulas (1.1% vs. 10.7%, p = 0.011) occurred more frequently in patients receiving conventional fluid management. Moreover, the conventional fluid management group experienced longer hospital stays (9.0 vs. 11.5 days, p = 0.02). Lower intraoperative fluid volume accompanying conventional fluid management was associated with a higher risk of severe postoperative complications compared with higher volume in the goal-directed group (odds ratio 2.58 (95% confidence interval 1.04-6.42), p = 0.041). Conclusions The goal-directed group experienced severe complications less frequently. Our findings indicate that optimizing the intraoperative fluid administration benefits patients, while adopting a too-restrictive approach represents an inferior choice.Peer reviewe

Machine-Learning Analysis of Serum Proteomics in Neuropathic Pain after Nerve Injury in Breast Cancer Surgery Points at Chemokine Signaling via SIRT2 Regulation

Background: Persistent postsurgical neuropathic pain (PPSNP) can occur after intraoperative damage to somatosensory nerves, with a prevalence of 29–57% in breast cancer surgery. Proteomics is an active research field in neuropathic pain and the first results support its utility for establishing diagnoses or finding therapy strategies. Methods: 57 women (30 non-PPSNP/27 PPSNP) who had experienced a surgeon-verified intercostobrachial nerve injury during breast cancer surgery, were examined for patterns in 74 serum proteomic markers that allowed discrimination between subgroups with or without PPSNP. Serum samples were obtained both before and after surgery. Results: Unsupervised data analyses, including principal component analysis and self-organizing maps of artificial neurons, revealed patterns that supported a data structure consistent with pain-related subgroup (non-PPSPN vs. PPSNP) separation. Subsequent supervised machine learning-based analyses revealed 19 proteins (CD244, SIRT2, CCL28, CXCL9, CCL20, CCL3, IL.10RA, MCP.1, TRAIL, CCL25, IL10, uPA, CCL4, DNER, STAMPB, CCL23, CST5, CCL11, FGF.23) that were informative for subgroup separation. In cross-validated training and testing of six different machine-learned algorithms, subgroup assignment was significantly better than chance, whereas this was not possible when training the algorithms with randomly permuted data or with the protein markers not selected. In particular, sirtuin 2 emerged as a key protein, presenting both before and after breast cancer treatments in the PPSNP compared with the non-PPSNP subgroup. Conclusions: The identified proteins play important roles in immune processes such as cell migration, chemotaxis, and cytokine-signaling. They also have considerable overlap with currently known targets of approved or investigational drugs. Taken together, several lines of unsupervised and supervised analyses pointed to structures in serum proteomics data, obtained before and after breast cancer surgery, that relate to neuroinflammatory processes associated with the development of neuropathic pain after an intraoperative nerve lesion

Douleur Neuropathique 4 (DN4) stratifies possible and definite neuropathic pain after surgical peripheral nerve lesion

Background Douleur Neuropathique 4 (DN4) is a screening questionnaire to help identify neuropathic pain (NP) in clinical practice and research. We tested the accuracy of the DN4 questionnaire in stratifying possible NP (pNP) and definite NP (dNP) in patients operated for breast cancer. Methods We studied 163 patients from a longitudinal cohort of breast cancer operated patients 4-9 years after surgery. pNP or dNP were classified according to the NP grading system. Surgeon-verified intercostobrachial nerve resection was used as a confirmatory test for dNP. A receiver-operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to test the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of the DN4. Additionally, we studied clinical factors that associated with a positive screening outcome in the interview part of the DN4 (DN4i). Results DN4i and DN4 showed significant accuracy in stratifying patients with pNP or dNP with cut-off scores 3 and 4 resulting to sensitivity of 66.2% and 79.4% and specificity of 77.8% and 92.6%, respectively. pNP and dNP patients showed differences in sensory descriptors of pain according to DN4i items. Screening positive on DN4i associated with dNP and younger age. Conclusions Full DN4 could stratify pNP and dNP patients in a chronic postsurgical NP patient group operated for breast cancer. Additionally, DN4i showed significant accuracy in stratifying pNP and dNP, but an examination is necessary to obtain proper accuracy. Demographic factors may have an impact on the screening outcome of DN4i. Significance DN4 stratifies possible and definite postsurgical peripheral neuropathic pain. DN4i may also show this, but full DN4 is more accurate. We confirm DN4i as a valid screening tool for NP.Peer reviewe

Machine-Learning Analysis of Serum Proteomics in Neuropathic Pain after Nerve Injury in Breast Cancer Surgery Points at Chemokine Signaling via SIRT2 Regulation

Background: Persistent postsurgical neuropathic pain (PPSNP) can occur after intraoperative damage to somatosensory nerves, with a prevalence of 29–57% in breast cancer surgery. Proteomics is an active research field in neuropathic pain and the first results support its utility for establishing diagnoses or finding therapy strategies. Methods: 57 women (30 non-PPSNP/27 PPSNP) who had experienced a surgeon-verified intercostobrachial nerve injury during breast cancer surgery, were examined for patterns in 74 serum proteomic markers that allowed discrimination between subgroups with or without PPSNP. Serum samples were obtained both before and after surgery. Results: Unsupervised data analyses, including principal component analysis and self-organizing maps of artificial neurons, revealed patterns that supported a data structure consistent with pain-related subgroup (non-PPSPN vs. PPSNP) separation. Subsequent supervised machine learning-based analyses revealed 19 proteins (CD244, SIRT2, CCL28, CXCL9, CCL20, CCL3, IL.10RA, MCP.1, TRAIL, CCL25, IL10, uPA, CCL4, DNER, STAMPB, CCL23, CST5, CCL11, FGF.23) that were informative for subgroup separation. In cross-validated training and testing of six different machine-learned algorithms, subgroup assignment was significantly better than chance, whereas this was not possible when training the algorithms with randomly permuted data or with the protein markers not selected. In particular, sirtuin 2 emerged as a key protein, presenting both before and after breast cancer treatments in the PPSNP compared with the non-PPSNP subgroup. Conclusions: The identified proteins play important roles in immune processes such as cell migration, chemotaxis, and cytokine-signaling. They also have considerable overlap with currently known targets of approved or investigational drugs. Taken together, several lines of unsupervised and supervised analyses pointed to structures in serum proteomics data, obtained before and after breast cancer surgery, that relate to neuroinflammatory processes associated with the development of neuropathic pain after an intraoperative nerve lesion

Changes in CRP and CA19-9 during Preoperative Oncological Therapy Predict Postoperative Survival in Pancreatic Ductal Adenocarcinoma

Introduction: Tumor and systemic inflammatory markers predict survival. This retrospective study aimed to explore the changes in CRP, CA19-9, and other routine laboratory tests during preoperative oncological therapy as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). Methods: Between 2000 and 2016, 68 borderline resectable PDAC patients received preoperative oncological therapy and underwent subsequent surgery at Helsinki University Hospital, Finland. We investigated changes in CRP, CA19-9, CEA, albumin, leukocytes, bilirubin, and platelets and examined the impact on survival. Results: In the multivariate analysis, CRP remaining at >= 3 mg/L after preoperative oncological therapy predicted a poorer postoperative outcome when compared to CRP decreasing to or remaining at 90% during preoperative treatment predicted a favorable postoperative outcome (HR 0.297, 95% CI: 0.124-0.708, p = 0.006). In the Kaplan-Meier analysis, the median survival for patients with CRP remaining at = 3 mg/L (42 months vs. 24 months, p = 0.001). Patients with a CA19-9 decrease >90% or level normalization (toPeer reviewe

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients : a cross-sectional study

Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02-36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6-127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN.Peer reviewe

The expression and prognostic value of toll-like receptors (TLRs) in pancreatic cancer patients treated with neoadjuvant therapy

Publisher Copyright: Copyright: © 2022 Nurmi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objectives Toll-like receptors (TLRs) play a pivotal role in the immune system and carcinogenesis. There is no research on TLR expression and association with survival among preoperatively treated pancreatic cancer patients. We studied the expression intensity and prognostic value of TLRs in pancreatic cancer patients treated with neoadjuvant therapy (NAT) and compared the results to patients undergoing upfront surgery (US). Method Between 2000 and 2015, 71 borderline resectable patients were treated with NAT and surgery and 145 resectable patients underwent upfront surgery at Helsinki University Hospital, Finland. We immunostained TLRs 1–5, 7, and 9 on sections of tissue-microarray. We classified TLR expression as 0 (negative), 1 (mild), 2 (moderate), or 3 (strong) and divided into high (2–3) and low (0–1) expression for statistical purposes. Results Among TLRs 1, 3, and 9 (TLR1 81% vs 70%, p = 0.008; TLR3 92% vs 68%, p = 0.001; TLR9 cytoplasmic 83% vs 42%, p<0.001; TLR9 membranous 53% vs 25%, p = 0.002) NAT patients exhibited a higher immunopositivity score more frequently than patients undergoing upfront surgery. Among NAT patients, a high expression of TLR1 [Hazards ratio (HR) 0.48, p<0.05] associated with a longer postoperative survival, whereas among US patients, high expression of TLR5 (HR 0.64, p<0.05), TLR7 (HR 0.59, p<0.01, and both TLR7 and TLR9 (HR 0.5, p<0.01) predicted a favorable postoperative outcome in separate analysis adjusted for background variables. Conclusions We found higher immunopositive intensities among TLRs 1, 3, and 9 in NAT patients. A high TLR1 expression associated with a longer survival among NAT patients, however, among US patients, high expression intensity of TLR5 and TLR7 predicted a favorable postoperative outcome in the adjusted analysis.Peer reviewe