Pään ja kaulan alueen sädehoidon suunnittelussa käytettävän magneettikuvausprotokollan optimointi

Tiivistelmä. Sädehoidon suunnittelussa hoitoalueen ja riskielinten rajaamiseen käytetään tietokonetomografiakuvien lisäksi magneettikuvia. Tämän tutkimuksen tarkoituksena oli optimoida kaulan alueen sädehoidon suunnittelun magneettikuvausprotokolla, joka sisältää kontrastiaineella tehostetun T1+C-kuvauksen, T2-kuvauksen ja Stir-kuvauksen. Optimoinnin tavoitteena oli tutkia kuvan kirkkauden muuttumista kontrastiaineen signaalin intensiteetin vähetessä kuvauksen aikana T1+C kuvauksessa, selvittää mahdollisen rasvasuppression lisäämistä T2-kuvaukseen ja arvioida Stir-kuvauksen kuvaamista aksiaalisuunnassa nykyisen koronaalisuunnan sijaan. Lisäksi tavoitteena oli vähentää kokonaiskuvausaikaa heikentämällä tarvittaessa signaali-kohinasuhdetta (SNR). T1+C-kuvauksella kuvattiin neljä potilasta nykyisellä sekvenssillä kaksi kertaa peräkkäin kuvan kirkkauden muuttumisen tarkistamiseksi. T2-kuvauksella kuvattiin kolme vapaaehtoista nykyisellä ja optimoidulla sekvenssillä ja Stir-kuvauksella kolme vapaaehtoista ja neljä potilasta nykyisellä ja optimoidulla sekvenssillä. Kuvien laatua vertailtiin laskemalla nykyisen ja optimoidun kuvan SNR-arvot ja kontrasti-kohinasuhteen-arvot (CNR). T2-kuvista arvioitiin lisäksi rasvasuppression tasaisuutta poskipään, posken, kaulan ja olkapään alueilla. Optimoinnin onnistumista kliinisesti selvitettiin onkologin suorittamalla arvioinnilla. T1+C-sekvenssissä peräkkäin kuvattujen kuvien kirkkaudessa havaittu ero ei johtanut selkeään tulokseen tuumorin näkyvyyden suhteen. Kontrastiaineen injektoinnin ja kuvauksen välisen aikaviiveen käytöstä tarvitaan siten lisätutkimuksia. T2-sekvenssissä kuvanlaatu säilyi samanlaisena, mutta kuvausaika kasvoi rasvasuppression lisäämisen vuoksi. Rasvasuppressiomenetelmän tuottamat rasva- ja vesisuppressoidut kuvat arvioitiin hyödyllisiksi tuumorin ja riskielinten piirtämisessä. Stir-sekvenssin optimoidussa aksiaalisuunnan kuvassa SNR-arvot heikkenivät hiukan, CNR-arvot säilyivät samansuuruisina ja kuvausaika pidentyi koronaalisuunnan kuviin verrattuna. Onkologi arvioi aksiaalisuunnan kliinisesti hyödyllisemmäksi kuin koronaalisuunnan, koska annossuunnittelu piirretään aksiaalisuunnan kuviin. Rasvasuppressio havaittiin tasaisemmaksi poskipään ja olkapään alueella kuin posken ja kaulan alueella. Optimoinnin tuloksena kaulan alueen kuvausprotokollan T2- ja Stir-sekvenssit vaihdetaan optimoiduiksi sekvensseiksi. Sekvenssien kuvanlaatu säilyi samantasoisena ja ne vastaavat paremmin sädehoidon suunnittelun kliinistä käyttöä, vaikka kokonaiskuvausaika kasvoi noin 4 minuuttia.Optimization of magnetic resonance imaging protocol for head and neck radiotherapy treatment planning. Abstract. Magnetic resonance imaging (MRI) is used to contour the treatment volume and risk organs in radiotherapy planning in addition to computed tomography images. The purpose of this study was to optimize the MRI protocol for radiotherapy planning of the neck. Protocol includes contrast-enhanced T1+C, T2 and Stir imaging. The aims of the optimization were to investigate the effect of delay after contrast injection in T1+C scan, to add fat suppression to T2 scan and to evaluate the axial slices instead of the coronal slices for Stir imaging. The goal was also to reduce acquisition time by decreasing the signal-to-noise ratio if necessary. Four patients scanned with the T1+C sequence two times to check for changes in image brightness. Three volunteers scanned with the current and optimized T2 sequences and four patients and three volunteers scanned with the current and optimized Stir sequences. Image quality was compared by calculating the signal-to-noise ratio (SNR) values and contrast-to-noise ratio (CNR) values of the current and optimized images. The uniformity of fat suppression was evaluated in cheek, neck and shoulder areas. The oncologist evaluated the success of the optimization from a clinical perspective. There was a difference in brightness in the images acquired one after another in T1+C, but it did not lead to a clear result in terms of tumor visibility. Thus, further studies are needed on the use of the time delay between contrast injection and imaging. In the T2 sequence, image quality remained similar, but acquisition time increased due to fat suppression. The fat- and water-suppressed images produced by the Dixon method were evaluated as useful for contouring tumor and risk organs. In the Stir sequence, the SNR of the optimized axial image decreased slightly, the CNR remained the same and the acquisition time increased compared to the coronal slices. The oncologist evaluated the axial slices to be more useful clinically than the coronal slices because treatment volume is contoured on axial images. Fat suppression was found to be more uniform shoulder area than in the cheek and neck areas. As a result of the optimization, the T2 Dixon and axial Stir sequences were approved for clinical use in the neck soft tissue imaging protocol. The image quality of the sequences remained the same and they are more in line with the clinical use of the treatment planning although the total acquisition time increased about 4 minutes

Henkilöstömitoituksen yhteys psyykelääkkeiden käyttöön muistisairaiden ympärivuorokautisessa hoidossa

Tiivistelmä. Muistisairauksiin liittyviä käytösoireita tulisi ensisijaisesti hoitaa lääkkeettömin, psykososiaalisin keinoin. Käytösoireiden rajoittaminen kemiallisesti on kansainvälisesti tunnustettu hoidon laadun ongelma. Tämän tutkielman tarkoituksena oli selvittää henkilöstömitoituksen yhteyttä psyykenlääkkeiden käyttöön muistisairaiden ympärivuorokautisessa hoidossa. Tavoitteena oli tuottaa tietoa muistisairaiden ympärivuorokautisen hoidon kehittämiseen ja arviointiin. Tutkimusmenetelmänä käytettiin kuvailevaa kirjallisuuskatsausta. Aineistohaku tehtiin CINAHL-, Scopus- ja Medic-tietokantoihin. Sisäänotto- ja poissulkukriteereiden avulla analyysiin valikoitui neljä alkuperäistä tutkimusartikkelia. Analyysimenetelmänä käytettiin kuvailevaa luokittelua. Henkilöstömitoitus, mutta myös henkilöstön koulutustausta vaikuttaa katsauksen mukaan merkittävästi psyykenlääkkeiden käyttöön ympärivuorokautisessa hoidossa olevilla muistisairailla. Sekä suurempi sairaanhoitajien määrä, että suurempi henkilöstömitoitus hoitoyksikössä vähensivät tehokkaasti psyykenlääkkeiden väärinkäyttöä. Henkilöstön kokema kuormitus potilaiden aggressiivisuuden tai levottomuuden vuoksi lisäsi psyykenlääkkeiden käyttöä. Tässä tutkimuksessa ei havaittu eroja yksityisessä ja julkisessa omistuksessa olevien hoivakotien välillä. Potilaasta johtuvilla tekijöillä oli myös merkittävä vaikutus psyykenlääkkeiden käyttöön, mutta tutkimusten välinen vaihtelu oli suurta. Lääkkeettömät hoitokeinot muistisairaan käytöshäiriöihin vaativat riittävästi osaavaa hoitohenkilöstöä. Kemiallisia rajoitteita voidaan käyttää halvempana vaihtoehtona lisähenkilöstön palkkaamiselle. Hoidon laadun valvonnan ja kuluttajien valintamahdollisuuden tukemiseksi aihetta tulisikin tutkia myös Suomessa aivan uudella tasolla

The effect of coating properties on the performance of a-C:H and ta-C films

DLC films cover a wide range of different carbon based coatings, starting from soft to extremely hard diamond-like carbon films. In this study two different types of DLC films have been studied in respect of their stress and strain characteristics and tribological performance. The coatings are hydrogenated amorphous carbon (a-C:H) coatings deposited by PECVD and tetrahedral amorphous carbon (ta-C) coating deposited by filtered arc technique. In order to evaluate the mechanical behaviour of the coatings under load, 3D FE modelling was carried out in combination with scratch testing. Also the tribological performance was evaluated with pin-on-disc tests using stepwise increasing normal load. The 3D FEM model was developed for calculating the stress and strain distributions of DLC coated systems and to evaluate how coating thickness and elastic properties affect the stress-strain state at crack initiation location. The simulation was compared to the findings to experimental observations in scratch test contact conditions, when the spherical diamond tip was moving with increased load on a coated surface. The coating performance was evaluated with scratch testing to detect the crack generation as well as the coating adhesion. When combining the simulated coating characteristics with empirical observation of coating fracture patterns the coating fracture performance and tolerance to cracking could be evaluated. A major effect of the coating elastic modulus on the stress and fracture behaviour of the coatings was observed. In the tribological testing the both coatings had a low friction performance. In the tribological testing with stepwise increasing load, the critical load for coating delamination was higher for the a-C:H coating, which is in accordance with the results of FE modelling of coating stress state

Durability and flexibility of chimpanzee grooming patterns during a period of dominance instability

Growing evidence from studies on primates and other taxa has shown that the maintenance of long-term affiliative patterns influences fitness. Thus, understanding how individuals regulate social interactions in response to environmental and social factors contributes to our understanding of the evolutionary basis of sociality. We investigated the durability of affiliation patterns in chimpanzees across three 3-month periods of varying social uncertainty depending on the degree of stability in the male hierarchy, with a 2-yr gap between each period. Periods were unstable (no clear alpha male), recently stable (new alpha male just established) and stable (alpha male in place for two years). We focused on three features of social exchange shared by human and non-human primates: consistency of exchanges across periods, durability of preferred partners, and degree of reciprocity in each period. We compared male-to-male, female-to-female, male-to-female and female-to-male grooming patterns. Overall, more grooming was exchanged in the stable period. Grooming patterns were not consistent across the three periods, but were only consistent between the recently stable and stable periods for female-to-female and male-to-female dyads. As predicted from the opportunistic nature of male relationships, male-to-male grooming was least likely to be correlated across all periods and males had relatively fewer durable (i.e., preferred partners in all periods) same-sex partners than females. Our predictions that grooming reciprocity would be less likely during the unstable period and in male-male dyads were only partially supported. We found grooming reciprocity in all periods for female-female dyads but only in the stable period for male-male and female-male dyads. Although long-term affiliative patterns are well studied in primates, this is the first study to investigate the association between social uncertainty and durability of affiliative patterns. Our findings suggest social uncertainty influences social exchange and highlight the importance of considering group instability in studies of social relationships

Absent Toll-like receptor-9 expression predicts poor prognosis in renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Toll-like receptor 9 (TLR9) is a cellular DNA-receptor whose activation with cognate ligands triggers an immune reaction, with increased production of inflammatory cytokines. The aim of this study was to examine the expression of TLR9 in renal cell carcinoma (RCC), which is generally renowned of its immunogenic nature. We also evaluated the prognostic value of TLR9 in RCC.</p> <p>Methods</p> <p>TLR9 expression in RCC was characterized with immunohistochemistry in a retrospective study population of 152 RCC patients who underwent renal surgery. The TLR9 staining intensity was compared with clinical parameters.</p> <p>Results</p> <p>Of the studied tumours, 112 (81%) exhibited cytoplasmic TLR9 immunostaining. No association was detected between cytoplasmic TLR9 immunoexpression intensity and stage, nuclear grade, histological subtype or tumour necrosis. Cytoplasmic TLR9 immunoexpression was, however, a marker of favourable RCC specific survival both in univariate analysis and in multivariate regression model.</p> <p>Conclusions</p> <p>We conclude that TLR9 expression is an independent prognostic marker of RCC and the absence of TLR9 expression is related to poorer prognosis in RCC.</p

Follicle-Stimulating Hormone Levels and Subclinical Atherosclerosis in Older Postmenopausal Women

Recent studies of perimenopausal women suggest that follicle-stimulating hormone (FSH) levels may be associated with atherosclerosis, independent of estradiol. Whether FSH is related to atherosclerosis in older postmenopausal women, who have completed the menopausal transition, remains unknown. We assessed the relationship of serum FSH and estradiol levels with carotid artery intima-media thickness (IMT) among 587 postmenopausal participants in the Kuopio Ischemic Heart Disease Risk Factor Study (Kuopio, Finland). Participants were aged 53-73 years and not using hormone therapy at baseline (1998-2001). Mean IMT was measured via high-resolution ultrasonography. We observed a significant inverse association between FSH levels and IMT. Mean IMTs among women in quartiles 1-4 of FSH were 0.94 mm, 0.91 mm, 0.87 mm, and 0.85 mm, respectively (P-trend <0.001). After adjustment for age, estradiol, testosterone, body mass index (weight (kg)/height (m)(2)), lipids, and other factors, FSH levels remained significantly associated with IMT (regression coefficients for quartiles 2-4 vs. quartile 1 were -0.038, -0.045, and -0.062, respectively; P-trend = 0.01). Findings were strongest in women aged 64-73 years (P-trend = 0.006) and did not vary by body mass index. In contrast, estradiol levels were not related to IMT. In summary, high postmenopausal FSH levels were associated with a lower atherosclerotic burden, independent of estradiol, adiposity, and other factors. Our findings warrant replication and the further exploration of potential underlying mechanisms.Peer reviewe

Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a meta-analysis of 9 prospective cohort studies.

BACKGROUND: The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes. METHODS: Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total N = 117,878, 56.2 % female, mean age = 50.0 years, range = 25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMI < 18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis. RESULTS: Mean follow-up time was 9.1 years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants. CONCLUSIONS: This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention

Raman Spectroscopy and Machine Learning Enables Estimation of Articular Cartilage Structural, Compositional, and Functional Properties

Objective: To differentiate healthy from artificially degraded articular cartilage and estimate its structural, compositional, and functional properties using Raman spectroscopy (RS). Design: Visually normal bovine patellae (n = 12) were used in this study. Osteochondral plugs (n = 60) were prepared and artificially degraded either enzymatically (via Collagenase D or Trypsin) or mechanically (via impact loading or surface abrasion) to induce mild to severe cartilage damage; additionally, control plugs were prepared (n = 12). Raman spectra were acquired from the samples before and after artificial degradation. Afterwards, reference biomechanical properties, proteoglycan (PG) content, collagen orientation, and zonal (%) thickness of the samples were measured. Machine learning models (classifiers and regressors) were then developed to discriminate healthy from degraded cartilage based on their Raman spectra and to predict the aforementioned reference properties. Results: The classifiers accurately categorized healthy and degraded samples (accuracy = 86%), and successfully discerned moderate from severely degraded samples (accuracy = 90%). On the other hand, the regression models estimated cartilage biomechanical properties with reasonable error (≤ 24%), with the lowest error observed in the prediction of instantaneous modulus (12%). With zonal properties, the lowest prediction errors were observed in the deep zone, i.e., PG content (14%), collagen orientation (29%), and zonal thickness (9%). Conclusion: RS is capable of discriminating between healthy and damaged cartilage, and can estimate tissue properties with reasonable errors. These findings demonstrate the clinical potential of RS.Peer reviewe

Подростки-спортсмены строят двойную карьеру и благополучие в условиях двойного карьерного роста: роль факторов окружающей среды

Рукопись поступила в редакцию: 20.12.2021.Received: 20.12.2021.Цель исследования заключалась в изучении карьерного роста и благополучия спортсменов-подростков в условиях двойного карьерного роста. В исследовании выявлены особенности адаптивности к карьере в старших классах спортивной школы. В статье представлены данные относительно того, в какой степени самооценка и пол связаны с адаптивностью к двойной карьере, определены профили адаптации к карьере спортсменов-подростков, выявлены как ожидания студентов-спортсменов в зависимости от их успехов в спорте и учебе и соответствующие ожидания их родителей связаны с их профилями адаптации к карьере. Получены новые данные относительно того, как организационная культура спортивной школы влияет на построение карьеры спортсменов-подростков.The purpose of the scientific research was to study the career growth and well-being of adolescent athletes in conditions of dual career growth. The study revealed the features of adaptability to a career in high school of sports school. The article presents data on the extent to which self-esteem and gender are associated with adaptability to a dual career, the profiles of adaptation to the career of adolescent athletes have been defined, it is also revealed how the expectations of student-athletes depending on their success in sports and studies and the corresponding expectations of their parents are associated with their profiles of adaptation to a career. The new data on how the organizational culture of a sports school affects the career development of teenage athletes have been obtained