Pretibial hematomas – A real-world single-center study

Publisher Copyright: © 2022 The Author(s)We analyzed treatment, outcome, and risk factors for skin necrosis of 60 patients aged ≥65 years treated for a pretibial hematoma in the province of Kymenlaakso, Finland, between 2015 and 2019. Reviewing patients’ medical records revealed two cohorts with distinct trajectories in outcome. By comparing the cohorts, we were able to discover factors associated with the prognosis for generating skin necrosis and the need for operative treatment. Thirty-five (58.3%) patients healed without any management, and 25 (41.7%) patients were treated with hematoma evacuation, mostly for having generated skin necrosis (72%). Among operatively treated patients’ descriptions, such as “parchment skin” and “poor skin quality” were observed frequently (80%) in the medical records. This pathology, dermatoporosis, was statistically significant (p<0.0001) among patients with a complicated outcome of a pretibial hematoma. In addition to dermatoporosis, patients with hematoma evacuation were more fragile having a higher Charlson comorbidity index (p = 0.005), a greater need for a walking aid (p = 0.0002), and overall compromised independency (p = 0.033). Hospitalization and rehabilitation were prolonged in the operatively treated cohort, 6.4 days vs. 2 days, respectively. We recorded a delay in the diagnosis and hematoma evacuation (mean 6, range 0–51 days). In addition, six (10%) patients were misdiagnosed for having erysipelas or deep vein thrombosis indicating that pretibial hematomas are not recognized. Skin quality should be documented, and prompt surgical hematoma evacuation should be executed in fragile patients with dermatoporosis. This could prevent skin necrosis and the further need of wound care or surgical care, long hospitalization, and rehabilitation periods.Peer reviewe

Pretibial lacerations among elderly patients : A province-wide study from Kymenlaakso, Finland, 2015-2019

In this retrospective cohort study, we analysed treatment and outcomes among >= 65-year-old patients who experienced a traumatic pretibial laceration in the province of Kymenlaakso, Finland, between 2015 and 2019. We reviewed computerised medical records for 116 patients with a pretibial laceration, 107 of whom we analysed in further detail. Patients were traced from injury to healing, including rehabilitation periods in health care centres. As expected, the majority of patients were elderly women (67%). Most lacerations were superficial and small, explaining why treatment was mostly conservative. Only 11 (9.48%) patients were treated operatively with surgical debridement or a split-thickness skin graft. The number of overall complications in wounds was high, with a complication rate of 30.2%. Most complications were local wound infections. We found that wound healing took more than 3 months in 32% of patients. Thorough patient tracing revealed numerous follow-up visits and long rehabilitative hospitalisation periods, indicating a significant decline in patient independence and the excessive use of resources. Successful wound healing was eventually observed in 89.66% patients. Furthermore, no terminology regarding pretibial lacerations was found in patient records. This study indicates that pretibial lacerations remain poorly recognised and understood in Finland. (C) 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Patient-related reasons for late surgery cancellations in a plastic and reconstructive surgery department

Late cancellations of scheduled operations cause direct and indirect costs for a hospital and economic and emotional stress for the patient. Previously, late cancellation rates for scheduled operations in plastic surgery have been shown to be attributable to patient-related causes in the majority of cases. In this retrospective study, we sought to examine specifically the patient-related reasons for the late cancellations in a plastic surgery operating theatre at Helsinki University Hospital in Finland from 2013 to 2014. We calculated latency between the date of decision for surgery and the scheduled operation day. In cases where the surgery was rescheduled and performed before 31 December 2015, the rescheduled waiting time latency was calculated. We aimed to improve our knowledge of the causes of late cancellations to further optimise the operating theatre efficiency and propose a strategic algorithm to avoid late cancellations During the study period, 327 (5.5%) of all the scheduled operations were recorded as late cancellations. Of these, 45.3% were because of patient-related issues. Acute infection, change in medical condition not noticed before and operation no longer necessary were by far the most common causes of cancellation, comprising 63.5%. Sixty-six per cent of patient-related cancelled operations were performed later, especially when the specific reason was patient's acute illness. Root-cause analysis shows that most of the underlying reasons for the cancellations can be attributed to a failure in communication. The majority of these cancellations were considered to be preventable, thus emphasising the importance of communication and skilful multi-professional planning of the operating theatre list. © 2018 The Author(s)Peer reviewe

Aberrant expression of ALK and EZH2 in Merkel cell carcinoma

BACKGROUND: Distinct characteristic features categorize Merkel cell carcinoma (MCC) into two subgroups according to the Merkel cell polyomavirus infection. Many mutational studies on MCC have been carried out in recent years without identifying a prominent driver mutation. However, there is paucity reporting the expression of cancer genes at the RNA level in MCC tumors. In this study, we studied the RNA expression profiles of 26 MCC tumors, with a goal to identify prospective molecular targets that could improve the treatment strategies of MCC. METHODS: RNA expression of 50 cancer-related genes in 26 MCC tumors was analyzed by targeted amplicon based next-generation sequencing using the Ion Torrent technology and the expression compared with that of normal, non-cancerous skin samples. Sequencing data were processed using Torrent Suite Software. Expression profiles of MCV-negative and MCV-positive tumors were compared. Fluorescence in situ hybridization was performed to study ALK rearrangements and immunohistochemistry to study ALK expression in tumor tissue. RESULTS: ALK, CDKN2A, EZH2 and ERBB4 were overexpressed, and EGFR, ERBB2, PDGFRA and FGFR1 were underexpressed in MCC tumors compared to normal skin. In the MCV-negative tumors, MET, NOTCH1, FGFR3, and SMO were overexpressed and JAK3 and NPM1 were under-expressed compared to the MCV-positive tumors. CONCLUSIONS: High expression of ALK, CDKN2A and EZH2 was recorded in MCC tumors. No ALK fusion was seen by FISH analysis. Overexpression of EZH2 suggests its potential as a drug target in MCC.Peer reviewe

Fast fixed-point bicubic interpolation algorithm on FPGA

We propose a fast fixed-point algorithm for bicubic interpolation on FPGA. Bicubic interpolation algorithms on FPGA are mainly used in image processing systems and based on floating-point calculation. In these systems, calculations are synchronized with the frame rate and reduction of computation time is achieved designing a particular hardware architecture. Our system is intended to work with images or other similar applications like industrial control systems. The fast and energy efficient calculation is achieved using a fixed-point implementation. We obtained a maximum frequency of 27.26 MHz, a relative quantization error of 0.36% with the fractional number of bits being 7, logic utilization of 8%, and about 30% of energy saving in comparison with a C-program on the embedded HPS for the popular Matlab test function Peaks(25,25) data on SoCkit development kit (Terasic), chip: Cyclone V, 5CSXFC6D6F31C8. The experiments confirm the feasibility of the proposed method.fi=vertaisarvioitu|en=peerReviewed

Selective growth of InGaAs on nanoscale InP islands

The formation of an InGaAs quantum well on nanoscale InP islands by selective growth using metalorganic vapor phase epitaxy is demonstrated. The structures show intense low‐temperature photoluminescence at 1.35 eV. The blueshift of the emission peak by increasing the excitation intensity suggests that the carriers are three‐dimensionally confined. The insertion of quantum well into the islands allows a better control of the properties of structuresfabricated by the self‐organizing growth, a novel technique to realize nanoscale structures without using any lithographical process steps.Peer reviewe

Wind suppression by X-rays in Cygnus X-3

Context. The radiatively driven wind of the primary star in wind-fed X-ray binaries can be suppressed by the X-ray irradiation of the compact secondary star. This causes feedback between the wind and the X-ray luminosity of the compact star.Aims. We aim to estimate how the wind velocity on the face-on side of the donor star depends on the spectral state of the high-mass X-ray binary Cygnus X-3.Methods. We modeled the supersonic part of the wind by computing the line force (force multiplier) with the Castor, Abbott & Klein formalism and XSTAR physics and by solving the mass conservation and momentum balance equations. We computed the line force locally in the wind considering the radiation fields from both the donor and the compact star in each spectral state. We solved the wind equations at different orbital angles from the line joining the stars and took the effect of wind clumping into account. Wind-induced accretion luminosities were estimated using the Bondi-Hoyle-Lyttleton formalism and computed wind velocities at the compact star. We compared them to those obtained from observations.Results. We found that the ionization potentials of the ions contributing the most to the line force fall in the extreme-UV region (100-230 angstrom). If the flux in this region is high, the line force is weak, and consequently, the wind velocity is low. We found a correlation between the luminosities estimated from the observations for each spectral state of Cyg X-3 and the computed accretion luminosities assuming moderate wind clumping and a low mass of the compact star. For high wind clumping, this correlation disappears. We compared the XSTAR method used here with the comoving frame method and found that they agree reasonably well with each other.Conclusions. We show that soft X-rays in the extreme-UV region from the compact star penetrate the wind from the donor star and diminish the line force and consequently the wind velocity on the face-on side. This increases the computed accretion luminosities qualitatively in a similar manner as observed in the spectral evolution of Cyg X-3 for a moderate clumping volume filling factor and a compact star mass of a few (2-3) solar masses.Peer reviewe

Trade-offs among spatio-temporal management actions for a mixed-stock fishery revealed by Bayesian decision analysis

Management and conservation of populations that are harvested simultaneously present a unique set of challenges. Failure to account for differences in productivity and spatio-temporal abundance patterns can lead to over-exploitation of depleted populations and/or loss of potential yield from healthy ones. Mixed-stock fisheries (where a stock may comprise one or more populations of reared or wild origin) harvest multiple stocks, often in unknown proportions, and lack of tools for estimation of stock-specific harvest rates can hamper status evaluations and attainment of management goals. We present a method for evaluating stock-specific impacts of alternative harvest strategies, using coastal trap net fisheries for Atlantic salmon (Salmo salar) in the Baltic Sea as a case study. Our results demonstrate a large variation among stocks in coastal mixed fishery harvest rates, as well as large differences in harvest rates relative to stock-specific maximum sustainable yield (MSY) and recovery levels. Bayesian decision analysis showed that spatio-temporal management actions, such as delayed fishery opening and closed areas may be effective in improving probabilities of meeting management objectives for Baltic salmon. However, stocks did not respond uniformly to different management actions, highlighting the potential for trade-offs in reaching stock-specific targets that must be considered by managers

Elementary teachers’ reflections on their use of digital instructional resources in four educational contexts : Belgium, Finland, Sweden, and US

We examine teachers' reflections on incorporating digital instructional resources (DIRs) into their mathematics teaching. We analyze qualitative interviews with 39 elementary school teachers from four educational contexts: Belgium, Finland, Sweden, and the U.S., using a framework proposed by Pepin et al. (Int J Math Educ 46: 645-661, 2017) to consider opportunities for DIRs to shift elements of teaching and learning in potentially transformative ways. Teachers described three major domains of teaching practice where they used DIRs: (a) class instruction, (b) student practice, and (c) professional participation. We found that teachers readily used DIRs during class instruction and to support student practice, guided by their existing instructional goals, which were shaped in part by education structures in the context. Few teachers incorporated DIRs in ways that transformed typical learning spaces. We also found that DIRs impacted several aspects of teachers' professional practices, including professional learning and collaboration. In particular, participation in social media and resource sharing altered the nature of and ways teachers participated in their own professional learning. We assert that efforts to use DIRs to stimulate change need to begin with an understanding of teachers' current practices and use our findings to identify three potential levers that might support movement toward change.Peer reviewe

CO 2 capture, storage and reuse potential in Finland

Abstract Economical feasibility and potential of CO 2 capture, storage and reuse in Finland was evaluated under the National Programme on Technology and Climate Change (Climtech). In Finland, no suitable geologic formations exist to sequester CO 2 . The nearest potential CO 2 sequestration sites are offshore oil and gas fields in the North Sea and Barents Sea, which would mean a transport of 500-1000 km for captured CO 2 . With current knowledge, capturing CO 2 near the storage sites and investing to new cross-border electricity transmission capacity seems the most feasible option for Finland. Storing CO 2 as solid mineral carbonate could be an option in the future, since large resources of suitable silicates exist in Finland as natural minerals and as wastes of mining industry. The reuse potential of captured CO 2 is less than 0.5% of the annual CO 2 emissions.