Harjuregression ja lasson vertailu äidin rintamaidon oligosakkaridiaineistossa

Teknologian kehitys on yleistänyt suuret ja leveät aineistot myös lääketieteessä. Lineaarisen regression sovittaminen aineistoon ei aina ole mahdollista, kun havaintojen määrä on pieni muuttujien määrään verrattuna. Kutistamismenetelmillä pyritään korjaamaan PNS-estimoinnissa esiintyviä ongelmia kuten multikollineaarisuutta, poikkeavien havaintojen tuottamia ongelmia sekä estimaattorien varianssin kasvua, joka syntyy, kun muuttujien lukumäärä lähestyy havaintojen lukumäärää. Harjuregressio ja lasso ovat kutistamismenetelmiä, jotka perustuvat regressiokertoimien kutistamiseen. Menetelmät rajoittavat regressiokertoimia valitulla sakkofunktiolla ja tasoitusparametrilla. Harjuregressiossa sakkofunktiona toimii parametrien neliöiden summa ja lassossa parametrien itseisarvojen summa. Tasoitusparametri kontrolloi kutistamisen määrää; mitä suurempi parametrin arvo on, sitä enemmän regressioparametreja kutistetaan kohti nollaa. Lasso kykenee myös mallin valintaan, koska se voi kutistaa parametrit täsmälleen nollaksi. Elastinen verkko yhdistää lasson ja harjuregression hyödyt. Siltaregressio on taas näiden kahden menetelmän yleistys. Äidin rintamaidon oligosakkaridit ovat äidin rintamaidossa olevia hiilihydraatteja, joita lapsi ei käytä ravinnokseen. Tutkielmassa sovitetaan harjuregressio, lasso ja PNS-estimoitu lineaarinen regressio äidin rintamaidon oligosakkaridiaineistoon ja vertaillaan mallien tuottamia tuloksia ja niiden sopivuutta aineistoon. Tutkielmassa tutkitaan, miten nämä oligosakkaridit ennustavat lapsen painon z-scorea yhden vuoden iässä

Pregnancy potential and perinatal outcomes of embryos cryopreserved twice: a case–control study

Research questionWhat are the pregnancy and perinatal outcomes of twice-cryopreserved embryos compared with embryos cryopreserved once?DesignRetrospective register-based case–control study. The case group consisted of transfers of twice-cryopreserved embryos (n = 89), and the control group of transfers of embryos cryopreserved once (n = 304). Matching criteria were embryonic age at transfer and female age category of less than 35 years or 35 and greater.ResultsThe survival rate of twice-cryopreserved embryos was 92.2%, and 93.7% of the planned frozen embryo transfers (FET) could be completed. FET was performed with cleavage-stage embryos in 17 cases and 68 controls and with blastocysts in 72 cases and 238 controls. The rates of live birth (27.0% versus 31.9%, adjusted odds ratio [OR] 0.70, 95% CI 0.40–1.22, P = 0.21), clinical pregnancy (31.5% versus 36.8%, adjusted OR 0.71, 95% CI 0.42–1.21, P = 0.21) and miscarriage (4.5% versus 3.9%, adjusted OR 1.10, 95% CI 0.33–3.60, P = 0.88) in the case and the control groups were comparable. No difference was seen in the preterm delivery rate (cases 4.2% versus controls 10.3%, P = 0.69). Twenty-five children were born in the case group and 100 in the control group. No difference in birthweight was detected between the groups and there were no large for gestational age fetuses or congenital malformations in the case group.ConclusionsUncompromised live birth rates and neonatal outcomes may be expected after the transfer of twice-cryopreserved embryos. To avoid embryo wastage and transfer of multiple embryos, good quality surplus embryos from FET cycles may be cryopreserved again by vitrification.</p

Luovuttajan lymfosyytti-infuusiot allogeenisen kantasolujen siirron jälkihoidossa

JOHDANTO. Allogeenisen kantasolujen siirron (ASCT) jälkihoidossa luovuttajan lymfosyytti-infuusio (DLI) on mahdollinen hoitokeino pahanlaatuisen veritaudin relapsin ehkäisemiseksi tai hoitamiseksi. Tutkimuksessa selvitettiin DLI-hoidon tehoa Tyksin kantasolujensiirtoyksikössä.AINEISTO. Tyksissä vuosina 2009-2019 allogeenisen kantasolujen siirron jälkeen DLI:n sai 46 potilasta. Lymfosyytti-infuusioita annettiin ennakoivasti, kliinisen taudin hoidoksi tai profylaktisesti suuren relapsiriskin pienentämiseksi.TULOKSET. Ennakoivan hoidon saaneiden elinikä ja taudin etenemättömyysaika olivat merkitsevästi pidemmät kuin kliinisen taudin tai profylaktisen hoidon saaneiden. DLI-hoidon merkittävin riski on käänteishyljintä. Yli puolelle tutkimuksen potilaista ei ilmaantunut akuuttia tai kroonista käänteishyljintäreaktiota, mutta toisaalta yksi potilas kuoli akuuttiin ja yksi krooniseen käänteishyljintäreaktioon.PÄÄTELMÄT. DLI on keino lisätä siirron jälkeistä graft-versus-leukemia-vaikutusta. Sen hyöty on suurin ennakoivana hoitona vähäisen tautimäärän hoidossa. DLI-hoidon tehoon ja turvallisuuteen voidaan vaikuttaa sopivilla annoksilla ja liitännäishoidoilla.</p

Neighborhood Disadvantage, Greenness, and Population Density as Predictors of Breastfeeding Practices : A Population Cohort Study from Finland

Background Many environmental factors are known to hinder breastfeeding, yet the role of the family living environment in this regard is still poorly understood. Objectives We used data from a large cohort to identify associations between neighborhood characteristics and breastfeeding behavior. Methods Our observational study included 11,038 children (0-2 years) from the Southwest Finland Birth Cohort. Participant information was obtained from the Medical Birth Register and municipal follow-up clinics. Neighborhood socioeconomic disadvantage, greenness, and population density were measured for a period of 5 years prior to childbirth within the residential neighborhood on a 250 x 250-m grid. Any breastfeeding and breastfeeding at 6 months were the primary outcomes. Binary logistic regression models were adjusted for maternal health and socioeconomic factors. Results Adjusted analyses suggest that mothers living in less populated areas were less likely to display any breastfeeding (OR: 0.46; 95% CI: 0.36, 0.59) and breastfeeding at 6 months (OR: 0.37; 95% CI: 0.34, 0.40). Mothers living in highly disadvantaged neighborhoods were less likely to display any breastfeeding if the neighborhood was less populated (OR: 0.54; 95% CI: 0.30, 0.95) but more likely to breastfeed at 6 months if the neighborhood was highly populated (OR: 3.74; 95% CI: 1.92, 7.29). Low greenness was associated with higher likelihood of any breastfeeding (OR: 3.82; 95% CI: 1.53, 9.55) and breastfeeding at 6 months (OR: 4.41; 95% CI: 3.44, 5). Conclusions Our results suggest that neighborhood characteristics are associated with breastfeeding behavior in Finland. Unravelling breastfeeding decisions linked to the living environment could help identify interventions that will allow the appropriate support for all mothers and infants across different environmental challenges.Peer reviewe

The association between appendicitis severity and patient age with appendiceal neoplasm histology-a population-based study

Purpose Recent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology. Methods This nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor. Results The severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98-32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69-9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95-88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67). Conclusion More malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.Peer reviewe

Esidiabetes lisää valtimotautien riskiä – entä hoidon kustannuksia?

Lähtökohdat Esidiabetekseen liittyy suurentunut riski sairastua tyypin 2 diabetekseen sekä sydän- ja ­verisuonitauteihin. Diabeteksen ja sen lisäsairauksien hoitoon liittyy suuria kustannuksia. Menetelmät Esidiabeetikot tunnistettiin terveyskeskuksen potilasrekisteristä poikkeavien ­verensokeriarvojen perusteella. Heidän hoitoaan, lisäsairauksien määrää ja hoidon kustannuksia verrattiin saman alueen tyypin 2 diabeetikoiden ja vertailuryhmän potilaiden hoitoon ja kustannuksiin. Tulokset Esidiabeteksen esiintyvyys oli kaikissa ikäryhmissä lähes kaksinkertainen verrattuna ­tyypin 2 ­diabeteksen esiintyvyyteen. Lisäsairauksien esiintyvyys ja potilaskohtaiset kustannukset olivat e­sidiabeetikoilla suuremmat kuin vertailuryhmän potilailla, mutta pienemmät kuin tyypin 2 diabeetikoilla ­lähes kaikissa ­diagnoosiryhmissä. Päätelmät Esidiabetes ja lisäsairaudet lisäävät hoidon kustannuksia verrattuna potilaisiin, joilla on normaali sokeriaineenvaihdunta. Koska potilasmäärä on suurempi, kokonaiskustannukset ovat jopa suuremmat kuin tyypin 2 diabeetikoilla ja ne painottuvat enemmän erikoissairaanhoitoon. Hoito ja seuranta ei ole yhtä intensiivistä kuin diabeetikoilla.</p

Changes in body composition by age and obesity status in preschool-aged children: the STEPS study

Background/Objectives: Obesity in early childhood is associated with increased risk of chronic diseases, but studies of body composition at preschool ages are sparse. Therefore, we examined differences in body composition by sex and obesity status in Finnish preschool-aged children and within-individual changes in body composition in normal and overweight children.Subject/Methods: Body composition was measured using segmental multifrequency bioimpedance analysis (BIA) in 476 children and in 781 children at age 3 and 5 years, respectively. Of those, 308 had repeated BIA measurements at both ages. BMI-SDS was used for classification of normal weight and overweight children.Results: Sex difference in the amount of lean mass (LM) was already seen at 3 years of age (boys 11.7 kg, girls 11.3 kg; p p p p Conclusions: BIA-assessed body composition differs by sex and obesity status already at age of 3 years. For children who are or become overweight at very young age, the patterns for the changes in LM and FM by age are different than for normal weight children.</div

Spontaneous preterm delivery is reflected in both early neonatal and maternal gut microbiota

AbstractBackgroundAberrant gut microbiota composition in preterm neonates is linked to adverse health consequences. Little is known about the impact of perinatal factors or maternal gut microbiota on initial preterm gut colonization.MethodsFecal samples were collected from 55 preterm neonates (ResultsPreterm neonates exhibited significantly lower gut microbiota alpha diversity and distinct beta diversity clustering compared to term neonates. Spontaneous preterm birth was associated with distinct initial gut microbiota beta diversity as compared to iatrogenic delivery. Gestational age or delivery mode had no impact on the preterm gut microbiota composition. The cause of preterm delivery was also reflected in the maternal gut microbiota composition. The contribution of maternal gut microbiota to initial preterm gut colonization was more pronounced after spontaneous delivery than iatrogenic delivery and not dependent on delivery mode.ConclusionsThe initial preterm gut microbiota is distinct from term microbiota. Spontaneous preterm birth is reflected in the early neonatal and maternal gut microbiota. Transmission of gut microbes from mother to neonate is determined by spontaneous preterm delivery, but not by mode of birth.ImpactThe initial gut microbiota in preterm neonates is distinct from those born full term. Spontaneous preterm birth is associated with changes in the gut microbiota composition of both preterm neonates and their mothers. The contribution of the maternal gut microbiota to initial neonatal gut colonization was more pronounced after spontaneous preterm delivery as compared to iatrogenic preterm delivery and not dependent on delivery mode.Our study provides new evidence regarding the early gut colonization patterns in preterm infants.Altered preterm gut microbiota has been linked to adverse health consequences and may provide a target for early intervention.</p

Associations between human milk oligosaccharides and growth in infancy and early childhood

Background: Breastfeeding modulates infant growth and protects against the development of obesity. However, whether or not maternal variation in human milk components, such as human milk oligosaccharides (HMOs), is associated with programming of child growth remains unknown.Objective: Our objective was to determine the association between maternal HMO composition and child growth during the first 5 y of life. In addition, the association between maternal prepregnancy BMI and HMO composition was assessed.Methods: Human milk samples from 802 mothers were obtained from a prospective population-based birth cohort study, Steps to healthy development of Children (STEPS), conducted in Turku, Finland. HMO composition in these milk samples was analyzed by HPLC. Child growth data from 3 mo to 5 y were collected from municipal well-baby clinics and linked to maternal HMO composition data to test for associations.Results: Maternal HMO composition 3 mo after delivery was associated with height and weight during the first 5 y of life in children of secretor mothers. Specifically, HMO diversity and the concentration of lacto-N-neo-tetraose (LNnT) were inversely associated and that of 2'-fucosyllactose (2'FL) was directly associated with child height and weight z scores in a model adjusted for maternal prepregnancy BMI, mode of delivery, birthweight z score, sex, and time. Maternal prepregnancy BMI was associated with HMO composition.Conclusions: The association between maternal HMO composition and childhood growth may imply a causal relation, which warrants additional testing in preclinical and clinical studies, especially since 2'FL and LNnT are among the HMOs now being added to infant formula. Furthermore, altered HMO composition may mediate the impact of maternal prepregnancy BMI on childhood obesity, which warrants further investigation to establish the cause-and-effect relation.</p

Carotid artery longitudinal wall motion alterations associated with metabolic syndrome and insulin resistance

Background and aims: Our objective was to study relationships between the new biomarker of vascular health, carotid artery longitudinal wall motion (CALM) and metabolic syndrome (MetS).Methods: Carotid ultrasound and assessment of MetS and its components were performed with 281 subjects aged 30-45 years. In the longitudinal motion analysis, the amplitude of motion and the antegrade-oriented and retrograde-oriented components of motion between the intima-media complex and adventitial layer of the common carotid artery wall were assessed.Results: Metabolic syndrome, according to the harmonized criteria, was detected in 53 subjects (19%). MetS was significantly associated with increased antegrade and decreased retrograde longitudinal motion in the carotid artery wall. Augmented antegrade amplitude of longitudinal motion was associated with obesity (β = 0.149, p p p p p Conclusion: Metabolic syndrome and insulin resistance were associated with alterations in CALM. In particular, hypertension, obesity and hyperinsulinaemia were associated with reduced total peak-to-peak amplitude as well as increased antegrade and reduced retrograde amplitudes, all of which might be markers of unfavourable vascular health.</div