Advanced clinical MRI for better outcome in epilepsy surgery. Focusing on fMRI and prediction of verbal memory decline.

Abstract Aim: The aim of the thesis was to evaluate the use of advanced MRI technology to improve results of epilepsy surgery, with focus on language and memory functions. Methods: In paper I, 25 patients with drug-resistant epilepsy were retrospectively included in the study for having been referred to high resolution 3T MRI with and without surface coils. The surface coils were placed over the suspected epileptogenic zone. The efficacy of the coils was assessed and graded in relation to their placement. In papers II, III and IV, a functional MRI (fMRI) paradigm, including both a verbal encoding task and a visuospatial task, was designed and implemented. The medial temporal lobe (MTL) for memory and the anterior language area were studied. In paper III, a standard word generation fMRI paradigm was also included. In these three studies, the test was performed in 15 healthy right handed subjects (paper II), 6 patients with drug-resistant temporal lobe epilepsy (TLE) with mixed handedness and 10 controls (paper III) and 14 TLE patients eligible for resective surgery (paper IV), respectively. A bootstrap algorithm was used to calculate lateralization indices (LI) and LI-curves. In paper IV, a clinical risk assessment score was created from collected clinical data. Additional value from fMRI LI was correlated to post-surgical memory decline. Results: Surface coil 3T MRI did not contribute to detection of previously undiagnosed lesions. In 20% of patients, 3T MRI, compared with previous 1.0-1.5T MRI, provided new information about cortical lesions. The fMRI paradigm visualized memory-related activity in the MTL and provided information regarding language processes. LI and LI-curves for memory at group level were consistent with previous studies, but a variety of activation effects were found at the individual level. LI-curves added complementary information for individual subjects with uncharacteristic results. The verbal encoding task provided information on verbal memory, which had equal lateralization as language in right-handed subjects, but not always in left-handed subjects and TLE patients. Bilateral fMRI language representation was seen in 2 right TLE patients who later suffered verbal memory decline post-operatively. Conclusion: High resolution 3T MRI is valuable for lesion detection, but surface coils do not provide further crucial information. The fMRI paradigm activates memory and language areas that can be studied at an individual level using LIcurves. Analysis of language patterns seems to be important for prediction of memory outcome in both left and right TLE. fMRI indices may identify an unexpected high risk for post-operative verbal memory decline in right TLE patients

Changes in genomic inbreeding and diversity over half a century in Swedish Red and Swedish Holstein dairy cattle

Swedish Red (SR) and Swedish Holstein (SH) are the dominating commercial dairy cattle breeds in Sweden. Both breeds have undergone substantial changes during the last half century due to intensive selection for breeding goal traits, but also resulting from increased international exchange of breeding animals and genetic drift. The aim of this study was to learn more about changes in genomic diversity and inbreeding in these two breeds over time. Therefore, semen samples from old bulls were genotyped using the 150K Genomic Profiler SNP array and combined with 50K SNP array genotype data, obtained for more recent bulls from the Nordic Cattle Genetic Evaluation. Different measures of level of homozygosity, genomic inbreeding, relatedness and changes in allele frequency were estimated for bulls born during different time periods from the 1950s until 2020. In total, more than 33,000 SNPs for 9737 SR and 5041 SH bulls were included in the analysis using PLINK v1.9. The results showed higher average homozygosity for SR than for SH bulls up to around 2000, but the difference was very small after that. The average inbreeding coefficients based on deviation from expected homozygosity as well as on runs of homozygosity decreased until the early 1980s in both breeds, whereafter they started to increase again for SH, but stayed more stable for SR. From the 1990s onwards, SH displayed higher average inbreeding coefficients than SR. In the last studied birth year group (2015-2020), the mean inbreeding coefficient based on runs of homozygosity was 5.9% for SH and 3.7% for SR. A principal component analysis showed a pattern of genetic relationships related to the birth year period of the bulls, illustrating the gradual change of the genetic material within each breed. The change in allele frequency over time was generally larger for SH than for SR. The results show that the inbreeding level was higher half a century ago than at present, and the inbreeding levels were lower than in some other studied populations. Still, the increase seen for inbreeding coefficients and homozygosity, especially in SH during recent years, should be considered in future breeding strategies

Suun harvinaiset sairaudet

Suun sairaus määritellään Suomessa harvinaiseksi, jos sen esiintyvyys on 1/2000 tai vähemmän. Kokonaisuutena harvinaiset sairaudet ovat kuitenkin tärkeä osa kaikista sairauksista ja niiden tunteminen on olennainen osa potilaiden diagnosointia ja hoitoa. Tämän syventävien opintojen tutkielman tarkoituksena on luoda lyhyt ja ytimekäs suomenkielinen oppimateriaali tukemaan suupatologian oppikokonaisuuden harvinaisten sairauksien oppimista. Materiaali on tehty suupatologian oppikirjan Regezzi et al., (Eds.) Oral pathology, clinical pathologic correlations (2012) perusteella ja viimeisimpien aiheista tehtyjen tieteellisten julkaisujen perusteella. Jokaisesta suun harvinaisesta sairaudesta ilmenee niiden esiintyvyys, etiologia, taudin kuva, mahdollinen histopatologia ja hoito

Inkludering av flerspråklige barn i lek

Vi lever i et mangfoldig samfunn som er preget av ulikheter innen kultur, etnisitet, religion og språk. Mangfoldet kan føre til utfordringer og konflikter i samfunnet, men det kan også være en kilde til utvikling og berikelse. I følge Bergsland og Jæger (2022, s. 21) er nøkkelen å finne det interessevekkende i spennet mellom det kjente og det ukjente. Det ukjente, som jeg ville forske nærmere på, er flerspråklige barn i lek. Jeg landet dermed på temaet inkludering av flerspråklige barn i lek. Etter mine praktiske studier har jeg blitt bevisst på at det kan være utfordrende for flerspråklige barn å bli inkludert og delta i lek når språket ikke rekker til. Det vil si når barnet har norsk som andrespråk, noe som kan føre til at det er vanskeligere å forstå eller å gjøre seg forstått. Med utgangspunkt i det nevnte ovenfor, senteres bacheloroppgaven rundt begrepene inkludering, lekemiljø, flerspråklige barn, samhandling og pedagogisk tilrettelegging. Problemstillingen lyder dermed følgende: Hvordan kan lekemiljøet bidra til å fremme inkludering av flerspråklige barn i lek?publishedVersio

Deliberative mini-publics facilitating voter knowledge and judgement : Experiment from a Finnish local referendum

This article examines the use of a Citizens’ Jury as a source of voter information in the context of a government-initiated (top-down) referendum. Several studies show the capacity of the Citizens’ Initiative Review (CIR) to enhance voters’ knowledge and capacity of judgement in ballot initiative processes. However, similar procedures have not been tested outside the U.S.A. or in the context of government-initiated referendums. Our case is a Citizens’ Jury on Referendum Options organised in the municipality of Korsholm (Finland) in 2019. Even though the referendum concerned a contested municipal merger, we find that jury's participants were nonetheless satisfied with the deliberative process and found it impartial. A large majority of voters in Korsholm had read the statement by the jury and thought it was a useful and trustworthy source of information. Based on a field experiment, we find that reading the statement increased trust in the jury, factual knowledge, issue efficacy and perspective-taking.Peer reviewe

Aerosol formation and emissions from realistic compartment fires

Firefighters are occupationally exposed to a large number of toxic compounds (IARC 2010). The occupational exposure of firefighters has been classified as potentially carcinogenic (class 2B, IARC; (Straif K. et al. 2007)). Poorly quantified emission factors and low understanding of when various aerosol emissions are likely to form during a fire event (initiation, combustion, extinguishing) inhibit efforts to reduce exposure by interventions to the firefighting strategy. The study was designed to evaluate firefighters’ exposure to air pollutants and to allow identification of how aerosol emissions respond to burning conditions and interventions of the firefighting. The study was conducted at the MSB firefighter training facility in Revinge outside Lund, Sweden. Eight small (5x3x2 m) sheds were built to imitate small compartment environments: apartment, bedroom, workshop, etc. These sheds were ignited under realistic fire scenarios (e.g., accident, arson) and later used for training new fire investigators (forensic police). Firefighter students and teachers monitored and extinguished the fires in similar procedures to real fire events. A supervisor monitored the combustion conditions, allowing or restricting fresh-air flow into the fire by opening or closing of the main door.Fire emissions were extracted from the fire through a 10 m (Ø 6 mm) stainless steel pipe, diluted ~1:50 with HEPA and active charcoal filtered air. The diluted emissions were monitored with a battery of aerosol monitoring instruments. Instrumentation included an aerosol mass spectrometer (Aerodyne SP-AMS, Billerica USA), an aethalometer (AE33, Magee Sci. USA), a differential mobility spectrometer (DMS500, Cambustion, UK), CO2 monitor (LI-COR, USA), and a NO/NO2 monitor (2BTech, USA). Complementary background measurements were positioned downwind or sidewind of the fires. With this equipment we collected data with the aim to resolve relationships between combustion conditions and pollution formation during different phases of a fire response. The results showed that total particle mass (PM1) emissions correlated with CO2 emissions and thus fire intensity. The emissions were speciated according to equivalent black carbon (eBC), organic aerosol (OA) and polycyclic aromatic hydrocarbon (PAH) derived from AMS data. When speciated, different particle emissions were found to depend on activities of the firefighting and the supervisor responsible for allowing or restricting fresh air into the combustion environment. Most evidently, we found that restricting the access to O2 by closing the door resulted in a sharp increase of OA and even more pronounced, PAH. PAH increased by several orders of magnitude, suggesting that PAH exposure-risks may increase drastically when fires become under-ventilated. Extinguishing the fire with water quickly decreased all particle emissions. The results described are illustrated in Figure 1.Further analysis involves additional off-line analyses, derivation of emission factors, time-resolved speciated emission analysis and evaluation of relationships between emissions, burning conditions and firefighting strategies

Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial

BackgroundComprehensive geriatric assessment provided in hospital wards in frail patients admitted to hospital has been shown to reduce mortality and increase the likelihood of living at home later. Systematic geriatric assessment provided in emergency departments (ED) may be effective for reducing days in hospital and unnecessary hospital admissions, but this has not yet been proven in randomised trials.MethodsWe conducted a single-centre, randomised controlled trial with a parallel-group, superiority design in an academic hospital ED.ED patients aged >= 75 years who were frail, or at risk of frailty, as defined by the Clinical Frailty Scale, were included in the trial. Patients were recruited during the period between December 11, 2018 and June 7, 2019, and followed up for 365 days.For the intervention group, systematic geriatric assessment was added to their standard care in the ED, whereas the control group received standard care only.The primary outcome was cumulative hospital stay during 365-day follow-up. The secondary outcomes included: admission rate from the index visit, total hospital admissions, ED-readmissions, proportion of patients living at home at 365 days, 365-day mortality, and fall-related ED-visits.ResultsA total of 432 patients, 63% female, with median age of 85 years, formed the analytic sample of 213 patients in the intervention group and 219 patients in the control group.Cumulative hospital stay during one-year follow-up as rate per 100 person-years for the intervention and control groups were: 3470 and 3149 days, respectively, with rate ratio of 1.10 (95% confidence interval, 0.55-2.19, P=.78). Admission rates to hospital wards from the index ED visit for the intervention and control groups were: 62 and 70%, respectively (P=.10). No significant differences were observed between the groups for any outcomes.ConclusionSystematic geriatric assessment for older adults with frailty in the ED did not reduce hospital stay during one-year follow-up. No statistically significant difference was observed for any secondary outcomes. More coordinated, continuous interventions should be tested for potential benefits in long-term outcomes.Trial registrationThe trial was registered in the ClinicalTrials.gov (registration number and date NCT03751319 23/11/2018).Peer reviewe

The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation : a multicenter, observational, prospective European study (EUROSAF)

Background: Literature suggests that different risks of mortality could influence physicians in prescribing or not anticoagulants in older patients with atrial fibrillation (AF). The Multidimensional Prognostic Index (MPI) can be considered a tool for the detection of multidimensional frailty. The aim of this cross-sectional study was to evaluate whether prescription patterns of oral anticoagulants exist, based on MPI values. Methods: Older hospitalised patients (age >= 65 years) with non-valvular AF were included across 24 European centres. MPI was calculated using validated and standardised tools derived from a comprehensive geriatric assessment. Other functional and clinical information were collected to calculate indexes specific for haemorrhagic and thromboembolic risk in AF. Results: Altogether, 2,012 participants affected by AF (mean age was 83.2 +/- 7.5, range: 65-104 years), with a higher presence of women (57.0%), were included. Overall, 440 took vitamin K antagonists VKAs (22.0%), 667 (33.4%) direct oral anticoagulants (DOACs), whilst 44.6% did not take any anticoagulant treatment. Prescription of anticoagulants was associated with MPI values, with people taking anticoagulants having lower mean MPI values. Anticoagulant therapy was not used in 53.1% of the group with the highest risk of mortality, compared with 32.3% of those in the group with the lowest mortality risk. People with higher scores in MPI were less frequently treated with anticoagulant therapy, after adjusting for several potential confounders. Conclusions: The EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) suggested that almost half of the older persons with AF do not receive anticoagulants and that MPI is an important determinant in prescribing or not anticoagulants.Peer reviewe

Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer's Disease : Does Exercise Modify the Risk?

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