Vastasyntyneen elvytys - elvytysohje ja elvytyksen seurantalomake sairaalan ulkopuoliseen ensihoitoon

Tämän opinnäytetyön tarkoituksena oli tehdä elvytysohje huonon vastasynty-neen varalle sekä vastasyntyneen elvytyksen seurantalomake Etelä-Karjalan sosiaali- ja terveyspiirille. Elvytysohje tehtiin voimassa olevan Käypä hoito -suosituksen (2008) pohjalta ja työn tekohetkellä päivitettävänä olleeseen suositukseen tulevista muutoksista saatiin tietoa Suomalaisen Lääkäriseuran Duodecimin ja Suomen Perinatologisen Seuran Suomen Neonatologit -alajaoksen asettaman työryhmän puheenjohtaja Liisa Rovamolta. Tavoitteena oli tehdä selkeä ja helppokäyttöinen vastasyntyneen elvytysohje sairaalan ulkopuoliseen ensihoitoon, elvytyksen seurantalomake vastasyntyneen tilan arviointia ja elvytyksen seurantaa varten sekä muistisääntö elvytystä varten. Opinnäytetyöraportissa sekä vastasyntyneen elvytysohjeessa lähteinä käytettiin Käypä hoito -suositusta, ammattikirjallisuutta, luentomateriaaleja, lääkärikonsultaatioita sekä voimassa olevia elvytysohjeita sairaalan sisältä. Elvytysohje sisältää täysiaikaisen vastasyntyneen elvytysohjeen, elvytysvälineistön, neste- ja lääkehoito taulukot painokilojen mukaan sekä elvytyksen seurantalomakkeen. Opinnäytetyöraportissa käsiteltiin vastasyntyneen anatomisia ja fysiologisia muutoksia syntymän jälkeen sekä elvytyksen erityispiirteitä ja elvytysvälineitä ensihoidon näkökulmasta. Lisäksi opinnäytetyöraportissa kerrottiin tilastoja synnytyksistä sairaalan ulkopuolella, käytiin läpi elvytykseen varautumista, elottomuuden toteamista ja hoitoa, elvytyksestä pidättäytymistä sekä elvytyksen jälkeistä hoitoa. Tarkoituksena oli, että tämä elvytysohje tulisi käyttöön Etelä-Karjalan sosiaali- ja terveyspiirin ensihoitoon ja olisi tukena vastasyntyneen elvytyskoulutusta suunniteltaessa. Jatkotutkimushaasteena on ennenaikaisen vastasyntyneen elvytys sekä muiden erikoistilanteiden, kuten traumapotilaan synnytys tai äidin hoito vastasyntyneen elvytyksen aikana.The purpose of this thesis was to create a resuscitation guide for a high risk newborn and a form for documentation of newborn resuscitation outside the hospital to be used in the South Karelia Social and Health Care District. The resuscitation guide was created based on the Finnish Current Care Guidelines, a Finnish unit producing evidence-based treatment guidelines for the Finnish Medical Society, ”Duodecim“ (2008). This recommendation was being updated while this final thesis was written but the information about the upcoming changes in the recommendation were given by Liisa Rovamo, chairman of the work group set by “Duodecim” and the Finnish Society of Perinatology. The aim was to create a resuscitation guide which would be clear and easy to use outside the hospital environment, as well as a documentation form for evaluating the newborn’s condition and following the resuscitation, and also a mnemonic for the whole resuscitation procedure. Other sources of information used for the theory in this thesis included professional literature, lecture materials, medical consultations and internal resuscitation guides used by the hospital. The resuscitation guide created for this thesis includes the guidelines for newborn resuscitation, a list of resuscitation equipment, the charts for liquids and medicines based on body weight, and a follow-up form for a full-term newborn. This final thesis discusses the anatomical and physiological changes in a newborn right after the birth, and also the special features of newborn resuscitation and equipment from the perspective of emergency health care. This final thesis also contains statistics about deliveries outside the hospital and discusses preparedness for newborn resuscitation. Furthermore, this thesis studies noticing and treating lifelessness in newborns, deciding not to resuscitate, and giving treatment post-resuscitation. The purpose was that this resuscitation guide would be used by South Karelia Social and Health Care District's emergency units, and it might be used to support planning newborn resuscitation training. Further challenges for research are found in premature newborn resuscitation and other special situations such as delivery of a trauma patient and the care of the mother during the newborn resuscitation

"Kipeimmät kokemukset ovat kasvun kannalta tärkeimmät." Laadullinen tutkimus parisuhde-erojen ja eronneen naisen esittämisen diskursseista Me Naiset -lehden henkilöhaastatteluissa 1970-2010-luvuilla

Tämä pro gradu -tutkielma tarkastelee parisuhde-erojen ja eronneen naisen esittämisen diskursseja Me Naiset -lehden henkilöhaastatteluissa 1970–2010-luvuilla. Tutkimus selvittää, kuinka parisuhde-erojen representoinnin tavat ja erodiskurssit ovat muuttuneet vuosikymmenten aikana Me Naisten henkilöhaastatteluissa. Lisäksi tutkimus paneutuu siihen, onko erojuttujen diskurssi positiivista ja onko parisuhteen päättymisellä vaikutusta haastateltavan naiseuteen. Kvalitatiivinen tutkimus on toteutettu teorialähtöisen sisällönanalyysin ja diskurssianalyysin avulla. Analyysin kolmena keskeisimpänä avaimena on käytetty käsitteitä naiseus, representaatio ja diskurssi. Tutkimus sijoittuu feministisen mediatutkimuksen sekä aikakauslehtijulkisuuden, erityisesti naistenlehtien julkisuuden, tutkimuksen kentälle liikkuen yksityisen ja julkisen väliseen rajankäyntiin liittyvissä kysymyksissä. Tutkimusaineisto koostuu Suomen suosituimman naistenlehden Me Naisten 51:stä henkilöhaastattelusta. Eroamista käsittelevät henkilöhaastattelut ovat olennainen osa naistenlehden vakiintunutta sisältöä. Historiallinen tarkastelu paljastaa, kuinka erokerronta ja sitä määrittelevät diskurssit ovat muovautuneet nykypäivän kaltaisiksi vuosikymmen kerrallaan. Ajalliset ja yhteiskunnassa vallitsevaa sukupuolisopimusta mukailevat muutokset ovat jättäneet jälkensä erojuttuihin sekä sisällöllisesti että rakenteellisesti. Tällaisia käännekohtia ovat esimerkiksi 1970-luvun julkisuuden intimisoituminen, 1990-luvun familisoituminen sekä 2000-luvun parisuhdemuotojen moninaistuminen avioliitoista parisuhteiksi ja romansseiksi. Me Naisten henkilöhaastatteluissa eropuhetta tuotetaan toistuvien ja toistensa kanssa risteävien diskurssien avulla. Näiden diskurssien sisällä ero reprentoidaan aina seurauksiltaan positiiviseksi ja haastateltavan naiseutta muokkaavaksi. Lukijoilleen erotarinat tarjoavat samaistumisen ja identiteetin peilaamisen paikan, mikä on omiaan luomaan kestäviä lukijasuhteita. Journalistisesti tuotetun erotarinan käsittelytapoja ohjaa eniten naistenlehden genre. Julkinen eropuhe vaikuttaa lukijoihinsa, luo malleja erokerrontaan ja myös heijastaa kulttuurissamme hyväksyttyjä ja arvostettuja asioita. Vuosikymmenten aikana Me Naiset on reagoinut sisällössään nopeasti heteroseksuaalisen avioelämän tapahtumiin ja naisen aseman yhteiskunnalliset muutokset ovat heijastuneet erohaastatteluihin. Nähtäväksi jää, millon 2010-luvulla mediajulkisuudessa paljon keskusteltu parisuhde- ja perhe-elämän monimuotoistuminen nostetaan vakiintuneeksi aiheeksi myös naistenlehden sivuille. Asiasanat:diskurssi, representaatio, naiseus, teorialähtöinen sisällönanalyysi, diskurssianalyysi, feministinen mediatutkimus, naistenlehti, naistenlehden julkisuus, parisuhde, eroamine

Sentinel node tumor burden in prediction of prognosis in melanoma patients

Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.Peer reviewe

Hydroquinone Induces NLRP3-Independent IL-18 Release from ARPE-19 Cells

Age-related macular degeneration (AMD) is a retinal disease leading to impaired vision. Cigarette smoke increases the risk for developing AMD by causing increased reactive oxygen species (ROS) production and damage in the retinal pigment epithelium (RPE). We have previously shown that the cigarette tar component hydroquinone causes oxidative stress in human RPE cells. In the present study, we investigated the propensity of hydroquinone to induce the secretion of interleukin (IL)-1 beta and IL-18. The activation of these cytokines is usually regulated by the Nucleotide-binding domain, Leucine-rich repeat, and Pyrin domain 3 (NLRP3) inflammasome. ARPE-19 cells were exposed to hydroquinone, and cell viability was monitored using the lactate dehydrogenase (LDH) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide salt (MTT) assays. Enzyme-linked immunosorbent assays (ELISAs) were used to measure the levels of proinflammatory cytokines IL-1 beta and IL-18 as well as NLRP3, caspase-1, and poly (ADP-ribose) polymerase (PARP). Hydroquinone did not change IL-1 beta release but significantly increased the secretion of IL-18. Cytoplasmic NLRP3 levels increased after the hydroquinone treatment of IL-1 alpha-primed RPE cells, but IL-18 was equally released from primed and nonprimed cells. Hydroquinone reduced the intracellular levels of PARP, which were restored by treatment with the ROS scavenger N-acetyl-cysteine (NAC). NAC concurrently reduced the NLRP3 levels but had no effect on IL-18 release. In contrast, the NADPH oxidase inhibitor ammonium pyrrolidinedithiocarbamate (APDC) reduced the release of IL-18 but had no effect on the NLRP3 levels. Collectively, hydroquinone caused DNA damage seen as reduced intracellular PARP levels and induced NLRP3-independent IL-18 secretion in human RPE cells.Peer reviewe

TAS-116, a Well-Tolerated Hsp90 Inhibitor, Prevents the Activation of the NLRP3 Inflammasome in Human Retinal Pigment Epithelial Cells

Chronic inflammation has been associated with several chronic diseases, such as age-related macular degeneration (AMD). The NLRP3 inflammasome is a central proinflammatory signaling complex that triggers caspase-1 activation leading to the maturation of IL-1 beta. We have previously shown that the inhibition of the chaperone protein, Hsp90, prevents NLRP3 activation in human retinal pigment epithelial (RPE) cells; these are cells which play a central role in the pathogenesis of AMD. In that study, we used a well-known Hsp90 inhibitor geldanamycin, but it cannot be used as a therapy due to its adverse effects, including ocular toxicity. Here, we have tested the effects of a novel Hsp90 inhibitor, TAS-116, on NLRP3 activation using geldanamycin as a reference compound. Using our existing protocol, inflammasome activation was induced in IL-1 alpha-primed ARPE-19 cells with the proteasome and autophagy inhibitors MG-132 and bafilomycin A1, respectively. Intracellular caspase-1 activity was determined using a commercial caspase-1 activity kit and the FLICA assay. The levels of IL-1 beta were measured from cell culture medium samples by ELISA. Cell viability was monitored by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and lactate dehydrogenase (LDH) measurements. Our findings show that TAS-116 could prevent the activation of caspase-1, subsequently reducing the release of mature IL-1 beta. TAS-116 has a better in vitro therapeutic index than geldanamycin. In summary, TAS-116 appears to be a well-tolerated Hsp90 inhibitor, with the capability to prevent the activation of the NLRP3 inflammasome in human RPE cells.Peer reviewe

Only IL-1β release is inflammasome-dependent upon ultraviolet B irradiation although IL-18 is also secreted

Abstract DNA damage accumulates in aged postmitotic retinal pigment epithelium (RPE) cells, a phenomenon associated with the development of age-related macular degeneration. In this study, we have experimentally induced DNA damage by ultraviolet B (UVB) irradiation in interleukin-1α (IL-1α)-primed ARPE-19 cells and examined inflammasome-mediated signaling. To reveal the mechanisms of inflammasome activation, cells were additionally exposed to high levels of extracellular potassium chloride, n-acetyl-cysteine, or mitochondria-targeted antioxidant MitoTEMPO, prior to UVB irradiation. Levels of interleukin-18 (IL-18) and IL-1? mRNAs were detected with qRT-PCR and secreted amounts of IL-1?, IL-18, and caspase-1 were measured with ELISA. The role of nucleotide-binding domain and leucine-rich repeat pyrin containing protein 3 (NLRP3) in UVB-induced inflammasome activation was verified by using the NLRP3-specific siRNA. Reactive oxygen species (ROS) levels were measured immediately after UVB exposure using the cell-permeant 2?,7?-dichlorodihydrofluorescein diacetate (H2DCFDA) indicator, the levels of cyclobutane pyrimidine dimers were assayed by cell-based ELISA, and the extracellular levels of adenosine triphosphate (ATP) determined using a commercial bioluminescence assay. We found that pro-IL-18 was constitutively expressed by ARPE-19 cells, whereas the expression of pro-IL-1? was inducible by IL-1α priming. UVB induced the release of mature IL-18 and IL-1? but NLRP3 contributed only to the secretion of IL-1?. At the mechanistic level, the release of IL-1? was regulated by K+ efflux, whereas the secretion of IL-18 was dependent on ROS production. As well as K+ efflux, the cells released ATP following UVB exposure. Collectively, our data suggest that UVB clearly stimulates the secretion of mature IL-18 as a result of ROS induction, and this response is associated with DNA damage. Moreover, in human RPE cells, K+ efflux mediates the UVB-activated NLRP3 inflammasome signaling, leading to the processing of IL-1?.Peer reviewe

Resvega Alleviates Hydroquinone-Induced Oxidative Stress in ARPE-19 Cells

Retinal pigment epithelial (RPE) cells maintain homeostasis at the retina and they are under continuous oxidative stress. Cigarette smoke is a prominent environmental risk factor for age-related macular degeneration (AMD), which further increases the oxidant load in retinal tissues. In this study, we measured oxidative stress and inflammatory markers upon cigarette smoke-derived hydroquinone exposure on human ARPE-19 cells. In addition, we studied the effects of commercial Resvega product on hydroquinone-induced oxidative stress. Previously, it was observed that Resvega induces autophagy during impaired protein clearance in ARPE-19 cells, for which it has the potential to alleviate pro-inflammatory pathways. Cell viability was determined while using the lactate dehydrogenase (LDH) and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays, and the cytokine levels were measured using the enzyme-linked immunosorbent assay (ELISA). Reactive oxygen species (ROS) production were measured using the 2′,7′-dichlorofluorescin diacetate (H2DCFDA) probe. Hydroquinone compromised the cell viability and increased ROS production in ARPE-19 cells. Resvega significantly improved cell viability upon hydroquinone exposure and reduced the release of interleukin (IL)-8 and monocytic chemoattractant protein (MCP)-1 from RPE cells. Resvega, N-acetyl-cysteine (NAC) and aminopyrrolidine-2,4-dicarboxylic acid (APDC) alleviated hydroquinone-induced ROS production in RPE cells. Collectively, our results indicate that hydroquinone induces cytotoxicity and increases oxidative stress through NADPH oxidase activity in RPE cells, and resveratrol-containing Resvega products prevent those adverse effects.Peer reviewe

Recurrent and Metastatic Cutaneous Squamous Cell Carcinomas in a Cohort of 774 Patients in Finland

Dermato-Venereologica Recognising patients with high risk cutaneous squamous cell carcinomas is essential in planning effective monitoring. The aim of this study was to determine the rate of local recurrences and metastases of cutaneous squamous cell carcinomas in a previously defined patient cohort in Finland. Pathology database search was performed to identify cutaneous squamous cell carcinoma patients and their medical records were reviewed. The cohort consisted of 774 patients with 1,131 cutaneous squamous cell carcinoma tumours. Overall, 4.2% (48/1,131) of the tumours were metastatic and 2.2% (25/1,131) had a local recurrence. Three of the metastatic tumours and 8 of the recurrent tumours had an invasion depth ofPeer reviewe

Premalignant lesions, basal cell carcinoma and melanoma in patients with cutaneous squamous cell carcinoma

The incidence of keratinocyte carcinomas is increasing worldwide and currently there is no standardised strategy for the follow-up of patients with multiple tumours. The objective of this study was to assess the prevalence of premalignant lesions, i.e., actinic keratosis and Bowen's disease, as well as basal cell carcinoma (BCC) and cutaneous melanoma (CM) among patients with cutaneous squamous cell carcinoma (cSCC). Pathology database search was performed to identify all cSCC patients diagnosed in the Pirkanmaa region of Finland in 2006-2015. Details of the patients and tumours were obtained through medical record review. The cohort consisted of 774 patients with 1131 cSCC tumours. Overall 559 patients (72%) had premalignant lesions. A total of 316 patients (41%) had BCC and 52% of these (n = 164) had more than one BCC tumour. 50 patients (6%) had CM. Overall 180 cSCC patients (23%) had no premalignant changes, BCC or CM. The median age of these patients was 6 years less than that of the patients with premalignant lesions (p <0.001) or BCC (p <0.001). The invasion depth of the tumours was deeper in the patients with only cSCC (median 3 mm, interquartile range 2-6) than in those with premalignant lesions or BCC (median 2 mm, interquartile range 1-3),p <0.001. CSCC patients have a high risk of developing multiple skin cancers and need long-term follow-up.Peer reviewe