EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Pientalojen korttelisuunnitelma ja pientalojen rakennussuunnittelu

Opinnäytetyössä syvennyttiin pientalojen kortteli- ja rakennussuunnitteluun. Lempäälän Kuljussa sijaitseville korttelialueille suunnitellaan yhdentoista rivitalon laajuinen alue vanhan harjatehtaan ympäristöön. Opinnäytetyön tilaajana oli Suomen Laatuneliö Oy. Työn tavoitteena oli laatia tilaajalle toteuttamiskelpoiset kahden pientalojen korttelin luonnossuunnitelmat ja tuottaa tilaajalle heidän rivitalokonseptiinsa lisämallistoa. Projekti koostuu kolmesta osasta: lähtötietojen selvittäminen ja analysointi, ehdotussuunnitteluvaihe ja lopullisten luonnospiirustusten suunnittelu. Lähtötiedot sisälsivät kaava-aineiston, jonka lisäksi tehtiin markkina-analyysi ja perehdyttiin yrityksen tavoitteisiin. Ehdotussuunnitteluvaiheessa syvennyttiin alueeseen ja korttelialueen tarjoamiin mahdollisuuksiin. Keskeiset suunnittelun kohteet olivat melun torjunta, tontille asemointi ja kaksikerroksiset rivitalot. Lopulliset ehdotussuunnitelmat sisältävät piirustuksia, havainnekuvia ja taulukoita. Suunnittelutyössä käytettiin Archicad-, Photoshop-, Excel-, Twinmotion-ohjelmia. Suunnittelun lopputuloksena valmistui yhtenäinen ja viihtyisä pientalokortteli. Yksi- ja kaksikerroksisia rakennuksia alueella on yksitoista. Opinnäytetyön dokumentteina tuotetiin ehdotussuunnitelmat, havainnekuvia ja taulukoita. Dokumentit tuotettiin L2-tasoisina arkkitehtipiirustuksina Harjastien kahteen korttelialueeseen. Tilaaja voi hyödyntää suunnitelmia yleissuunnitteluvaiheessa, josta laaditaan pääpiirustukset

Tietomallinnuksen hyödyntäminen pientalossa

Tässä opinnäytetyössä suunniteltiin 1,5-kerroksinen omakotitalo Lempäälään. Omakoti-talo on puurunkoinen ja perustettiin maanvaraisesti. Asiakkaana oli viisihenkinen perhe Lempäälästä. Opinnäytetyö sisältää sekä rakennussuunnittelun että rakennesuunnittelun. Suunnitelmat toteutettiin pääasiassa ArhciCAD-ohjelmalla, mutta apuna käytettiin myös Microsoft Exceliä sekä AutoCAD-suunnitteluohjelmaa. Suunnittelu aloitettiin hankeselvityksellä, jossa kartoitettiin hankkeen tiedot, tavoitteet, aikataulut ja suunnittelun lähtökohdat. Rakennussuunnitteluvaiheeseen sisältyi luonnosvaihe ja lopullisten kuvien tuottaminen. Rakennesuunnittelussa suunniteltiin kohteelle rakenteet. Rakenteet mitoitettiin FINWOOD-laskentaohjelmalla. Lisäksi pohditaan, mitä mahdollisuuksia tietomallinnuksella on pientalo kohteissa. Tietomallilla tarkoitetaan rakennuksen tietojen yhdistämistä yhdeksi kolmiulotteiseksi kokonaisuudeksi. Tietomallia hyödynnettiin tässä opinnäytetyössä lähinnä määrälaskentaan ja kuvien tuottamiseen. Tietomallinnuksesta oli suuri taloudellinen ja käytännöllinen hyöty tässä kohteessa. Suurimpia hyötyjä olivat muunneltavuus, arkkitehtikuvien tuottaminen ja määrälaskenta. Tietomallinnuksen hyötyjen määrä riippuu paljon ohjelmasta ja käyttäjän ammattitaidosta.In this Bachelor’s thesis 1,5-level house is designed to Lempäälä. As customer, is a 5-member family from Lempäälä. House is designed with wooden structure and the site is corner plot in the layout area. Bachelor’s thesis prepared project planning and architec-tural design of new building. ArchiCAD-program is used to design the house, but in additionally AutoCAD-program and Microsoft Excel-program are used. Design begins from project planning where prepared knowledges, goals, schedule and basic data for design of the project. In architectural plans outline drawling and architecture drawings is produced of the project. In structure plans all the structures are de-signed. Structures are dimensioned by FINNWOOD-dimension program. Additionally, in this Bachelor’s thesis how the BIM invocation can be reasonable of small buildings. In this project BIM invocation only quantity surveying and creating drawings. Key words: Architecture plans, structure plans, BI

Putative anoikis‐resistant subpopulations in colorectal carcinoma:a marker of adverse prognosis

Abstract Anoikis is a form of apoptosis induced when a cell loses contact with the extracellular matrix (ECM). Anoikis resistance is essential for metastasis formation, yet only detectable by in vitro experiments. We present a method for quantitation of putative anoikis‐resistant (AR) subpopulations in colorectal carcinoma (CRC) and evaluate their prognostic significance. We studied 137 CRC cases and identified cell subpopulations with and without stromal or extracellular matrix (ECM) contact with hematoxylin‐and‐eosin‐stained sections and immunohistochemistry for laminin and type IV collagen. Suprabasal cells of micropapillary structures and inner cells of cribriform and solid structures lacked both stromal contact and contact with ECM proteins. Apoptosis rate (M30) was lower in these subpopulations than in the other carcinoma cells, consistent with putative AR subpopulation. We determined the areal density of these subpopulations (number/mm² tumor tissue), and their high areal density independently indicates low cancer‐specific survival. In conclusion, we show evidence that subpopulations of carcinoma cells in micropapillary, cribriform, and solid structures are resistant to anoikis as shown by lack of ECM contact and low apoptosis rate. Abundance of these subpopulations is a new independent indicator of poor prognosis in CRC, consistent with the importance of anoikis resistance in the formation of metastasis

Putative anoikis resistant subpopulations are enriched in lymph node metastases and indicate adverse prognosis in colorectal carcinoma

Abstract Anoikis refers to apoptosis induced by the loss of contact with the extracellular matrix. Anoikis resistance is essential for metastasis. We have recently shown that it is possible to quantitatively evaluate putative anoikis resistant (AR) subpopulations in colorectal carcinoma (CRC). Abundance of these multi-cell structures is an independent marker of adverse prognosis. Here, we have quantified putative AR subpopulations in lymph node (LN) metastases of CRC and evaluated their prognostic value and relationship with the characteristics of primary tumors. A case series included 137 unselected CRC patients, 54 with LN metastases. Areal densities (structures/mm²) of putative AR structures in primary tumors had been analyzed previously and now were determined from all nodal metastases (n = 183). Areal density of putative AR structures was higher in LN metastases than in primary tumors. Variation of the areal density within different LN metastases of a single patient was lower than between metastases of different patients. Abundance of putative AR structures in LN metastases was associated with shorter cancer specific survival (p = 0.013), and this association was independent of T and N stages. Abundance of putative AR structures in primary tumors and LN metastases had a cumulative adverse effect on prognosis. Enrichment of putative AR subpopulations in LN metastases suggest that in metastasis formation, there is a selection favoring cells capable of forming these structures. Higher intra-case constancy relative to inter-case variation suggests that such selection is stable in metastasis development. Our findings indirectly support the biological validity of our concept of putative AR structures

To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both