Hodgkinin lymfooman kansallinen laaturekisteri:klassisen Hodgkinin lymfooman hoitotulokset Helsingin ja Uudenmaan sairaanhoitopiirin alueella

Tiivistelmä. Hodgkinin lymfooma on yleisin imukudoksen syöpä alle 20-vuotiailla. Suomessa uusia tapauksia todetaan noin 130 vuodessa, ja ilmaantuvuus on pysynyt melko vakaana. Hodgkinin lymfooman ennuste nuorilla aikuisilla on hyvä, noin 10 % potilaista kuolee tautiin. Iäkkäiden potilaiden tauti on vaikeampi hoitaa. Parantuneiden osuus on vuosikymmenien varrella kasvanut ja vakiintunut noin 85 %:n tasolle 2000-luvulla. Tutkimuksen tarkoitus: Tämän tutkielman tarkoituksena on selvittää klassista Hodgkinin lymfoomaa sairastavien potilaiden ensimmäisen hoitolinjan vasteet sekä potilaiden ennuste tutkimalla tapahtumavapaata elinaikaa sekä kokonaiselinaikaa. Tavoitteena on tutkia muun muassa sukupuolen, iän ja tupakoimisen vaikutusta näihin päätetapahtumiin. Erityisesti tutkitaan ≥60-vuotiaiden taudin etenemisen syitä. Aineisto: Helsingin ja Uudenmaan sairaanhoitopiirin alueelta kerättiin 159 potilaan aineisto retrospektiivisesti Suomen Hematologiseen Rekisteriin. Menetelmät: Potilailla oli todettu klassinen Hodgkinin lymfooma aikavälillä 2012–2017. Potilasaineistosta tehtiin tilastoanalyysejä liittyen ensimmäisen hoitolinjan vasteeseen, tapahtumavapaaseen elinaikaan sekä kokonaiselinaikaan. Tulokset: Ensimmäisen hoitolinjan jälkeen täydellisen hoitovasteen sai 110 potilasta ja osittaisen hoitovasteen 27 potilasta. Ei vastetta/etenevä tauti oli 12 potilaalla. Erisukupuolilla ja tupakointiryhmillä ei olluttilastollisesti merkitsevää eroa tapahtumavapaassa elinajassa tai kokonaiselinajassa. Tapahtumavapaa elinaika ja kokonaiselinaika olivat lyhyempiä vanhemmalla ikäryhmällä (≥60-vuotiaat) kuin nuoremmalla (16–59-vuotiaat) (EFS(5v): 27 % vs. 81 %,

Degradation of human kininogens with the release of kinin peptides by extracellular proteinases of Candida spp.

The secretion of proteolytic enzymes by pathogenic microorganisms is one of the most successful strategies used by pathogens to colonize and infect the host organism. The extracellular microbial proteinases can seriously deregulate the homeostatic proteolytic cascades of the host, including the kinin-forming system, repeatedly reported to he activated during bacterial infection. The current study assigns a kinin-releasing activity to secreted proteinases of Candida spp. yeasts, the major fungal pathogens of humans. Of several Candida species studied, C. parapsilosis and C. albicans in their invasive filamentous forms are shown to produce proteinases which most effectively degrade proteinaceous kinin precursors, the kininogens. These enzymes, classified as aspartyl proteinases, have the highest kininogen-degrading activity at low pH (approx. 3.5), but the associated production of bradykinin-related peptides from a small fraction of kininogen molecules is optimal at neutral pH (6.5). The peptides effectively interact with cellular B2-type kinin receptors. Moreover, kinin-related peptides capable of interacting with inflammation-induced B1-type receptors are also formed, but with a reversed pH dependence. The presented variability of the potential extracellular kinin production by secreted aspartyl proteinases of Candida spp. is consistent with the known adaptability of these opportunistic pathogens to different niches in the host organism

Clinical Alarms in a Gynaecological Surgical Unit: A Retrospective Data Analysis

Alarm fatigue refers to the desensitisation of medical staff to patient monitor clinical alarms, which may lead to slower response time or total ignorance of alarms and thereby affects patient safety. The reasons behind alarm fatigue are complex; the main contributing factors include the high number of alarms and the poor positive predictive value of alarms. The study was performed in the Surgery and Anaesthesia Unit of the Women’s Hospital, Helsinki, by collecting data from patient monitoring device clinical alarms and patient characteristics from surgical operations. We descriptively analysed the data and statistically analysed the differences in alarm types between weekdays and weekends, using chi-squared, for a total of eight monitors with 562 patients. The most common operational procedure was caesarean section, of which 149 were performed (15.7%). Statistically significant differences existed in alarm types and procedures between weekdays and weekends. The number of alarms produced was 11.7 per patient. In total, 4698 (71.5%) alarms were technical and 1873 (28.5%) were physiological. The most common physiological alarm type was low pulse oximetry, with a total of 437 (23.3%). Of all the alarms, the number of alarms either acknowledged or silenced was 1234 (18.8%). A notable phenomenon in the study unit was alarm fatigue. Greater customisation of patient monitors for different settings is needed to reduce the number of alarms that do not have clinical significance

Review article: the diagnostic approach and current management of chylous ascites

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138889/1/apt14284.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138889/2/apt14284_am.pd

Dopamine D_2-receptor activation elicits akinesia, rigidity, catalepsy, and tremor in mice expressing hypersensitive 4 nicotinic receptors via a cholinergic-dependent mechanism

Recent studies suggest that high-affinity neuronal nicotinic acetylcholine receptors (nAChRs) containing α4 and β2 subunits (α4β2*) functionally interact with G-protein-coupled dopamine (DA) D_2 receptors in basal ganglia. We hypothesized that if a functional interaction between these receptors exists, then mice expressing an M2 point mutation (Leu9'Ala) rendering 4 nAChRs hypersensitive to ACh may exhibit altered sensitivity to a D_2-receptor agonist. When challenged with the D_(2)R agonist, quinpirole (0.5–10 mg/kg), Leu9'Ala mice, but not wild-type (WT) littermates, developed severe, reversible motor impairment characterized by rigidity, catalepsy, akinesia, and tremor. While striatal DA tissue content, baseline release, and quinpirole-induced DA depletion did not differ between Leu9'Ala and WT mice, quinpirole dramatically increased activity of cholinergic striatal interneurons only in mutant animals, as measured by increased c-Fos expression in choline acetyltransferase (ChAT)-positive interneurons. Highlighting the importance of the cholinergic system in this mouse model, inhibiting the effects of ACh by blocking muscarinic receptors, or by selectively activating hypersensitive nAChRs with nicotine, rescued motor symptoms. This novel mouse model mimics the imbalance between striatal DA/ACh function associated with severe motor impairment in disorders such as Parkinson’s disease, and the data suggest that a D_(2)R–α4*-nAChR functional interaction regulates cholinergic interneuron activity.—Zhao-Shea, R., Cohen, B. N., Just, H., McClure-Begley, T., Whiteaker, P., Grady, S. R., Salminen, O., Gardner, P. D., Lester, H. A., Tapper, A. R. Dopamine D2-receptor activation elicits akinesia, rigidity, catalepsy, and tremor in mice expressing hypersensitive α4 nicotinic receptors via a cholinergic-dependent mechanism

Sources and pathways of dust during the Australian 'Millennium Drought' decade

From the late 1990s to mid-2010, Australia was affected by a prolonged period of drought, the “Millennium Drought,” during which numerous severe dust storms crossed the continent. We inspect this period to produce the first continental-scale climatology of air-parcel trajectories that is specific to dust and use it to gain new insights into dust transport dynamics over the eastern half of Australia. The analysis is based upon dust arrival times from airport meteorological observations made at nine mostly coastal cities for 2000–2009. The Hybrid Single-Particle Lagrangian Integrated Trajectory model was used to calculate 1.26 million backward trajectories from receptor cities, with only those trajectories associated with a dust storm observation considered in the analysis of dust transport. To tie dust trajectories from receptors to likely emission sources, trajectories were linked to six known major dust source regions in and around the Lake Eyre Basin. The Lake Eyre North ephemeral lake system, alluvial-dominated Channel Country, and agricultural Mallee-Riverina regions emerge as important sources for the period, providing variable contributions to different parts of the seaboard as controlled by different front-related wind systems. Our study also provides new detail regarding dust pathways from continental Australia. For the Millennium Drought we identify that the broadly established Southeast Dust Path may be more accurately subdivided into three active pathways, driven by prefrontal northerly winds and a variation in the influence of frontal westerlies. The detail of these pathways has implications for dust delivery from specific Australian sources to different marine environments