Serum caspase-cleaved cytokeratin-18 fragment as a prognostic biomarker in hematological patients with febrile neutropenia

The study aim was to determine the benefit of the measurement of serum caspase-cleaved cytokeratin-18 (CK-18) fragment as a prognostic marker of febrile neutropenia (FN) in hematological patients. The study population consisted of 86 consecutive patients with FN who received intensive chemotherapy for hematological malignancy at the adult hematology ward of Kuopio University Hospital. Twenty-three patients (27%) had acute myeloid leukemia, and 63 patients (73%) were autologous stem cell transplant recipients. Serum caspase-cleaved CK-18 fragment M30, C-reactive protein (CRP) and procalcitonin (PCT) were measured at the onset of FN (d0), on day 1 (d1), and on day 2 (d2). Eight patients (9%) developed severe sepsis, including three patients with septic shock. Eighteen patients (21%) had a blood culture-positive infection. Serum CK-18 fragment peaked on the first day after fever onset in patients with severe sepsis. Higher CK-18 level was associated with severe sepsis, intensive care unit treatment, and fatal outcome, but not with blood culture positivity. In ROC curve analysis, d1 serum CK-18 fragment predicted severe sepsis with an area under the curve (AUC) of 0.767, CRP with an AUC of 0.764, and PCT with an AUC of 0.731. On d2, the best predictive capacity was observed for CRP with an AUC of 0.832. The optimal cutoff of caspase-cleaved CK-18 fragment M30 for predicting severe sepsis was 205 U/L on d1. In hematological patients, serum CK-18 fragment was found to be a potential prognostic marker of severe sepsis at early stages of FN.Peer reviewe

Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus

Background - Structural changes occur in the pancreas as a part of the natural aging process. With aging, also the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. Fecal elastase-1 is a good marker of pancreatic exocrine secretion. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus. Methods - A total of 159 patients participated in this cross-sectional study. 106 older individuals (aged 60-92 years) were recruited from outpatient clinics and elderly homes. They were divided to three age groups: 60-69 years old (n = 31); 70-79 years old (n = 38) and over 80 years old (n = 37). 53 young subjects (20-28 years old) were investigated as controls. Inclusion criteria were age over 60 years, normal status and competence. Exclusion criteria were any special diet, diabetes mellitus, any known gastrointestinal disease or prior gastrointestinal surgery. Fecal elastase-1 concentration was measured from stool samples with an ELISA that uses two monoclonal antibodies against different epitopes of human elastase-1. Results - Fecal elastase-1 concentrations correlated negatively with age (Pearson r = -0,3531, P < 0.001) and were significantly lower among subjects over 70 years old compared to controls (controls vs. 70-79 years old and controls vs. over 80 years old, both P < 0.001). Among the over 60 years old subjects, the fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 (21.7%) individuals [mean 112 (86-138) μg/g] indicating pancreatic exocrine insufficiency. Of those, 9 subjects had fecal elastase-1 level below 100 μg/g as a marker of severe pancreatic insufficiency. Conclusion - In our study one fifth of healthy older individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might benefit from enzyme supplementation therapy.peerReviewe

Energiansäästö Vihreä lippu -ohjelmassa

Opinnäytetyön tilaajana toimi ympäristökasvatuksen asiantuntijajärjestö Suomen Ympäristökasvatuksen Seura ry. Työn tavoitteena oli selvittää Vihreä lippu -ympäristökasvatusohjelmaan energia-teemalla osallistuneiden päiväkotien, koulujen, oppilaitosten ja vapaa-ajantoimijoiden saavuttamaa energiansäästöä. Työn teoriaosuudessa käsitellään energiankäytön ympäristönäkökulmia sekä etenkin kuntatason energiansäästön ohjauskeinoja. Lisäksi perehdytään ympäristökasvatukseen, kestävän kehityksen rooliin varhaiskasvatuksessa ja perusopetuksessa sekä kasvatuksellisiin keinoihin energiansäästöä tavoiteltaessa. Lukijalle esitellään myös toimeksiantaja sekä Vihreä lippu -ohjelman periaatteet. Tutkimus suoritettiin hyödyntämällä Vihreä lippu -ohjelmaan osallistuneiden koulujen ja päiväkotien raportointia sekä täydentämällä sitä sähköpos-tikyselyiden avulla. Tutkimukseen osallistui yhteensä 17 toimijaa 27:stä vuosien 2011 ja 2012 aikana Vihreän lipun energia-teemalla saavuttaneesta osallistujasta. Näin tutkimus kattoi noin 63 prosenttia tutkittavasta perusjoukosta. Aineistoa analysoitiin tilastollisia menetelmiä hyödyntäen. Tulosten perusteella osallistujat saavuttivat ohjelman aikana sähkön osalta säästöä 95 prosentin todennäköisyydellä 3,9–12,2 prosenttia. Keskimääräinen säästö oli 8 prosenttia. Lämpöenergian ja veden osalta tuloksissa oli suurta hajontaa. Säästöihin vaikuttivat muun muassa käytetyt toimenpiteet sekä energiansäästöä häirinneet tekijät, kuten energiaa runsaasti kuluttavien laitteiden hankinnat. Lisäksi lämpöenergian kohdalla tuloksiin vaikutti osallistujien mahdollisuus säätää rakennuksen lämpötilaa ja ilmanvaihtoa. Tutkimustulosten perusteella Vihreä lippu-osallistujia voidaan kehottaa selvittämään omaa energiankulutustaan edellisiltä vuosilta niin sähkön kuin lämpöenergiankin osalta. Näin voitaisiin osallistujakohtaisesti panostaa joko sähkön- tai lämpöenergiansäästötoimiin ja saavuttaa optimaaliset tulokset juuri kyseiselle yksikölle.This Bachelor’s thesis is commissioned by The Finnish Association for Environmental Education. The aim of the thesis was to research savings of energy consumption in those kindergartens, schools, learning institutions and leisure operators who participated in the Eco-Schools programme. The review of the literature focuses on environmental effects of energy usage and directing methods of energy savings especially in municipal level. It also deals with environmental education, educational methods in energy savings and the role of sustainable development in education. The reader is also introduced to The Finnish Association for Environmental Education and to the basics of the Eco-Schools programme. The research was done by making use of reports of the schools and kindergartens which had participated in the Eco-Schools programme and by complementing it with email questionnaires. 17 operators from 27 who achieved The Green Flag in years 2011 and 2012 participated to this research. Thus the research covers about 63 percentile of the target population. The data was analyzed with statistical methods. According to the research, participants have 95 percent chance of gaining 3,9–12,2 percent savings in electricity usage. The average saving was 8 percent. Diversity among the heating energy and water usage was large. Saving methods and inhibitive factors like purchases of electrics with high consumption had a big influence on the results. Also among the heating energy the possibility of adjusting the temperature and air conditioning of the building had a positive influence on the savings. According to the results, the participants can be recommended to sort out their electricity usage from previous years. By doing this every participant could concentrate on the saving methods of either electricity or heating energy and gain optimal results in energy conservation

Elinvoiman ja elonkirjon puolesta : ekologinen jälleenrakennus kunnissa pandemian jälkeen

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