Vanhan Rauman portit

Insinöörityön tavoitteena oli perehtyä Vanhan Rauman portteihin suunnittelijan, puusepän ja sepän näkökulmasta. Myös talojen asukkaiden näkökannan ja mielipiteiden huomioon ottaminen oli tärkeää. Kaupungin arvokkaat puuportit ovat valitettavan lyhytikäisiä ja niiden ennenai-kainen tuhoutuminen on yleinen ongelma. Insinöörityössä perehdyttiin vanhojen porttien suunnittelussa ja valmistuksessa tehtyihin virheisiin. Tavoitteena oli löytää valmistusmenetelmiä ja -materiaaleja, joita käyttämällä uusien porttien käyttöikä saadaan maksimoitua. Porttien tuhoutuminen johtuu pääasiallisesti rakenteellisista ja valmistuksellisista virheistä sekä huollon puutteesta. Jotta portista saadaan kestävä ja pitkäikäinen, on sen valmistukseen liittyvien osatekijöiden hallinta olennaista. Yksittäinenkin virhe saattaa nopeuttaa portin tuhoutumista jopa vuosikymmenillä. Erityisen haitalliseksi kestävyyden kannalta osoittautuivat väärät materiaalivalinnat, puun ja metallin välinen korroosio sekä virheellisen pintakäsittelyn aiheuttama puun lahoaminen. Koska Vanhassa Raumassa on runsaasti vaurioituneita portteja, työssä käsitellään myös niiden korjaustoimenpiteitä.The aim of this thesis was to study the manufacturing of the gates of Old Rauma from the designer´s, carpenter´s and blacksmith´s points of view. The resident´s point of view and opinions was also important to take into account. The valuable gates of the city are regrettably short-lived and their premature destruction is a common problem. The objective of this thesis was to study errors which have been made in the manufacturing process of the old gates. Another objective was to search for proper manufacturing methods and materials to maximize the life span of the new gates. Primary reasons for the destruction are defects due to the structure and manufac-ture, and lack of maintenance. To manufacture a durable and long lasting gate, it is essential to consider the whole manufacturing process. A single mistake can speed up the destruction of the gate even by decades. Particularly harmful to the durability are wrong choice of materials, corrosion between wood and metal and incorrect treatment of surface caused by the decaying wood. Because there are lots of damaged gates in the Old Rauma area, the work also deals with their repairs

Ketä hoidetaan, kun tehohoitopaikat loppuvat?

Otsikon kysymys nousi keskiöön, kun koronapandemia viime keväänä lähti leviämään kulovalkean tavoin ympäri maailmaa, ja kriittisesti sairastuneiden potilaiden määrä ylitti terveydenhuollon kapasiteetin monissa maissa. Pulaa oli lääkäreistä, hoitajista, suojavarusteista, hoitovälineistä ja -tiloista. Kuka saa viimeisen paikan, kun kapasiteetti on loppumassa? Kenellä on oikeus päättää siitä?</p

Clinical Study of Nanofibrillar Cellulose Hydrogel Dressing for Skin Graft Donor Site Treatment

Objective: Skin graft donor site management is a concern particularly for elderly patients and patients with poor wound healing competence, and also because donor sites are a source of pain and discomfort. Although different types of dressings exist, there is no consensus regarding optimal dressing type on donor site care to promote healing, reduce pain, and improve patients' comfort. Approach: This prospective, single-center clinical trial evaluated the performance of nanofibrillar cellulose (NFC) wound dressing (FibDex (R) by UPM-Kymmene Corporation) for treatment of donor sites compared with a polylactide-based copolymer dressing. The study enrolled 24 patients requiring skin grafting with mean age of 49 +/- 18. The primary outcome measure was wound healing time. Secondary outcomes, the epithelialization, subjective pain, the scar appearance assessed using the Patient and Observer Scar Assessment Scale (POSAS), and skin elasticity and transepidermal water loss (TEWL), were evaluated at 1 and 6 months postoperatively. Results: No statistically significant differences were observed between NFC and copolymer dressings regarding wound healing time, epithelialization, experience of pain, or TEWL. Significant differences were observed in the POSAS results for thickness and vascularity in the Observer score, in the favor of NFC over copolymer dressing. Moreover, skin elasticity was significantly improved with NFC dressing in terms of viscoelasticity and elastic modulus at 1 month postoperatively. Innovation: NFC dressing is a new, green sustainable product for wound treatment without animal or human-origin components. Conclusion: NFC dressing provides efficient wound healing at skin graft donor sites and is comparable or even preferable compared with the copolymer dressing.Peer reviewe

Induction of CD73 prevents death after emergency open aortic surgery for a ruptured abdominal aortic aneurysm : a randomized, double-blind, placebo-controlled study

Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10 mu g) or matching placebo for 6 days after surgery. Major exclusion criteria included fatal hemorrhagic shock, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 min. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. The study was pre-maturely stopped due to a reported drug-drug interaction and was left under-powered. Out of 40 randomized patients 38 were included in the outcome analyses (27 IFN beta-1a and 11 placebo). There was no statistically significant difference between treatment groups at baseline except more open-abdomen and intestinal ischemia was present in the IFN beta-1a arm. D30 all-cause mortality was 22.2% (6/27) in the IFN beta-1a arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI 0.21-8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the IFN beta-1a arm vs. 9.1% in the placebo arm). Patients with high level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids and the presence of IFN beta-1a neutralizing antibodies associated with a poor CD73 response and survival. The initial aim of the trial, if postoperative INF beta-1a treatment results on better RAAA survival, could not be demonstrated. Nonetheless the anticipated target mechanism up-regulation of CD73 was associated with 100% survival. According to present results the INF beta-1a induced up-regulation of serum CD73 was blocked with both use of glucocorticoids and serum IFN beta-1a neutralizing antibodies. The study was pre-maturely stopped due to interim analysis after a study concerning the use if IV IFN beta-1a in ARDS suggested that the concomitant use of glucocorticoids and IFN beta-1a block the CD73 induction.Peer reviewe

Is sleep apnea a risk factor for Covid-19? findings from a retrospective cohort study

Background: In the early phase of the coronavirus disease-19 (Covid-19) pandemic, Southwest Finland remained relatively spared. By the 3rd of May 2020, a total of 28 patients have been admitted to the Turku University Hospital. We explore baseline characteristics in order to identify risk for severe disease and critical care admission.Methods: For this retrospective cohort study, data were derived from hospital records. Basic descriptive statistics were used to characterise patients, including medians, percentiles and frequencies. Differences were tested with Mann Whitney U-test and Pearson’s chi-square test.Results: Pre-existent obstructive sleep apnea (OSA) was present in 29% of patients admitted in the hospital for Covid-19. Overall, other findings on admission were comparable with those reported elsewhere. C-reactive protein and procalcitonin were higher in patients who were eventually transferred to critical care in comparison to in those who were not (median CRP 187 mg/L versus 52 mg/L, pConclusion: OSA was pre-existent in a disproportional large group of patients, which suggests that it is an important risk factor for severe Covid-19. Furthermore, we identified high CRP, PCT and possibly native oxygen saturation as useful clinical measures to identify patients at risk for critical care.</p

Tehohoidon kapasiteetti COVID-19-epidemiassa

Mitkä ovat käytössä olevat resurssit, miten ne saadaan riittämään ja kuinka hoito kohdennetaan mahdollisimman vaikuttavasti COVID-19-epidemian aikana? Tehohoitolääkärit vastaavat

Red blood cell transfusion induces abnormal HIF-1 alpha response to cytokine storm after adult cardiac surgery

Patients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1 alpha) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1 alpha levels were measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 +/- 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1 alpha levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1 alpha levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 alpha response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery.Peer reviewe

Tehohoidon kapasiteetti COVID-19-epidemiassa

Mitkä ovat käytössä olevat resurssit, miten ne saadaan riittämään ja kuinka hoito kohdennetaan mahdollisimman vaikuttavasti COVID-19-epidemian aikana? Tehohoitolääkärit vastaavat

Urheilijan COVID-19 : tarvitaanko rutiininomaisia kardiologisia selvityksiä?

Nuorten urheilijoiden COVID-19-infektiot ovat pääosin olleet lieväoireisia tai oireettomia. SARS-CoV-2-virus ei ole erityisen sydänhakuinen, mutta vaikeissa, sairaalahoitoa vaatineissa tilanteissa sydänlihaksen tai -pussin tulehdusta on nähty usein. Tutkimuksissa pienellä osalla urheilijoista on todettu magneettikuvauksella sydäntulehdukseen ­sopivia löydöksiä. Paluu urheiluun COVID-19-taudin jälkeen tulee aina tehdä vähitellen. Mikäli infektioon on liittynyt ­sydäntulehdus, täysipainoinen urheilu voi alkaa vasta täydellisen toipumisen jälkeen.</p