Surveillance in hereditary nonpolyposis colorectal cancer syndrome

Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited cancer predisposition syn-drome characterized by early onset colorectal cancer (CRC) and several other extra-colonic cancers, most commonly endometrial cancer (EC) and gastric cancer. Our aim was to evaluate the efficiency and results of the ongoing CRC and EC surveillance programs and to investigate the grounds for future gastric cancer screening by comparing the gastric biopsies of mutation positive and negative siblings in search for premalignant lesions. We also compared a new surveillance method, computerized tomographic colonoscopy (CTC) with optic colonoscopy. The patient material consisted of 579 family members from 111 Finnish HNPCC families al-most all harboring a known mismatch repair gene mutation. The efficacy of CRC and EC surveillance programs on HNPCC patients was evaluated by comparing the stage and survival of cancer cases detected with surveillance versus without. The performance of a new technique, CTC, was explored using a same-day colonoscopy as a reference standard. The use of intrauterine aspiration biopsies for EC surveillance was intro-duced for the first time in a HNPCC setting. Upper GI endoscopies were performed and biop-sies taken from mutation carriers and their mutation-negative siblings. The present surveillance program for CRC proved to be efficient. The CRC cases detected by surveillance were at a significantly more favorable stage than those in the non-surveilled group. This advantage was reflected in a significantly higher CRC-specific survival in the sur-veilled group. The performance of a new technique, CTC was found insufficient for polyp detection in this population in which every polyp, no matter the size, should be detected and removed. Colono-scopy was confirmed as a better surveillance modality than CTC. We could not observe any of the assumed differences in the gastric mucosa from mutation carriers and their mutation-negative siblings and no cases of gastric cancer were detected. The results gave no support for gastric surveillance. The EC surveillance program (transvaginal ultrasound and intra-uterine biopsy every 2-3 years) seemed to be efficient. It yielded several asymptomatic cancer cases and premalignant lesions. The stage distribution of the endometrial cancers in the group under surveillance tended to be more favorable than that of the mutation-positive, symptomatic EC patients who had no surveillance. None of the surveilled EC patients died of EC compared to six in the non-surveilled patients during the follow up. The improvement was, however, not statistically sig-nificant, thus far. Another observation was the good performance of endometrial aspiration biopsies used in this setting for the first time.

Kansallinen identiteetti ja suomalaiseksi samastuminen

National identity is a general, more or less shared meaning structure. Those who share it, identify with a nation according to their beliefs of what national identity consists of. The present study examined the Finnish national identity in relation to other spatial identities, such as local or European identity. Data were drawn from a sample of 179 respondents who represented the adult population in the year 1993. The focus was on the representation of the Finnish national identity, the limits and components of this identity, and on the position of national identification among all human identifications. Categorization, the basic process in the construction of national identity, consists of inclusion and exclusion. Different forms of identification could be distinguished along with different contents. Discrimination and derogation of outgroups were associated with identification that emphasized inter-nation comparison and framed identity in an essentialistic and thus exclusionary way. The contents of national identity were examined using a quantitative word-assessment method, and related to different forms of identification. With regard to Finnish identification, few differences between age, educational or SES groups were found. Despite the lack of differences in the strength of Finnish identification, those with more education to a greater extent relativized their Finnishness. Those who held positive attitudes to immigrants associated Finnishness with both positive and negative traits. Pro-immigrant attitude was related to an emphasis on cultural Finnishness and a de-emphasis on comparative and status-oriented Finnishness. Among the respondents with lower level of education, the emphasis on cultural Finnishness clearly predicted pro-immigrant attitudes. Those who did not produce any spontaneous response to a request to define Finnishness were more likely to be anti-immigrant. Thus, reflexive self-understanding implies openness towards other nationalities. Changes in the representation of Finnishness are suggested by differential weights given by respondents to different aspects of the national identity. Older respondents regarded the moral-anthropomorphic aspects of identity as more important. The younger respondents felt relatively more Finnish in the company of foreigners than did the older generations, to whom being with friends and in other close relationships stood out as contexts of national identification. The aspect of identity which is based on categorization and comparison could be called identity for others. The other aspect of the national identity is identity for ourselves, which emphasizes self and cultural self-understanding. A modern marketing oriented “image-of-Finland” identity represents identity for others.

"Ei sitä ainakaan helpommaksi tehdä sairaan opiskelijan elämää" : Pitkäaikaissairaiden kokemuksia korkeakoulutuksen esteistä ja mahdollisuuksista

This study examines the experiences of students with chronic illnesses in higher education. I chose to study rheumatic and other musculoskeletal diseases because they are group of diseases that are nationally significant in Finland. From students experiences I do interpretation of their agency. My research problems are: What kind of obstacles and possibilities student with chronic illness experiences in studying? What kind of obstacles illness set up for the agency or does it set any? How agency of student with chronic illness shows in the context of the university? I collected the data by using interview and focus group method. Additionally I had different kinds of documents of accessibility and equality in the university. Interviews were like halfstructured theme and open interviews. Focus group method I have applied. All the people that participated in the study were students from the university of Helsinki. They all have rheumatic or other musculoskeletal diseases. I have five interviewees and the group consisted of two people and the researcher. In the data analysis I use categorizing by the themes. Students that participated in my study spoke about their pain related experiences of their illness which also connected to their experiences of the higher education. Students agencies were limited the more they experienced pain. Pain forces students to certain activity one actions avoidance and another s favouring. If part-time studying would have been possible economically, it would have made the life easier for a part of the students. Students were aware of the available resources of their body for some of the students illness and life control set challenge and for some it set conditions. Students thought that university education is more possible to them than vocational education. Students didn t feel their own body limited in the context of university that emphasize intellectual and knowledge connected values and some of the students had reversed their illness as a resource of studying. However students felt their illness as a private matter and they considered illness profit and disadvantage before telling about it, which I interpretated limiting students agencies. In the university terms of students agencies were bond to individuality that came up in positive and negative. Freedom of studying was positive but official and individual study accommodations made agency bounded. Majority of the students didn t see possibilities to do differently in the university s practice but some of the students had recognised values underneath the practices that made it possible to reflect them, do differently and made space for agency.

Exact bounds for distributed graph colouring

A distributed system is a collection of networked autonomous processing units which must work in a cooperative manner. Currently, large-scale distributed systems, such as various telecommunication and computer networks, are abundant and used in a multitude of tasks. The field of distributed computing studies what can be computed efficiently in such systems. Distributed systems are usually modelled as graphs where nodes represent the processors and edges denote communication links between processors. This thesis concentrates on the computational complexity of the distributed graph colouring problem. The objective of the graph colouring problem is to assign a colour to each node in such a way that no two nodes connected by an edge share the same colour. In particular, it is often desirable to use only a small number of colours. This task is a fundamental symmetry-breaking primitive in various distributed algorithms. A graph that has been coloured in this manner using at most k different colours is said to be k-coloured. This work examines the synchronous message-passing model of distributed computation: every node runs the same algorithm, and the system operates in discrete synchronous communication rounds. During each round, a node can communicate with its neighbours and perform local computation. In this model, the time complexity of a problem is the number of synchronous communication rounds required to solve the problem. It is known that 3-colouring any k-coloured directed cycle requires at least ½(log* k - 3) communication rounds and is possible in ½(log* k + 7) communication rounds for all k ≥ 3. This work shows that for any k ≥ 3, colouring a k-coloured directed cycle with at most three colours is possible in ½(log* k + 3) rounds. In contrast, it is also shown that for some values of k, colouring a directed cycle with at most three colours requires at least ½(log* k + 1) communication rounds. Furthermore, in the case of directed rooted trees, reducing a k-colouring into a 3-colouring requires at least log* k + 1 rounds for some k and possible in log* k + 3 rounds for all k ≥ 3. The new positive and negative results are derived using computational methods, as the existence of distributed colouring algorithms corresponds to the colourability of so-called neighbourhood graphs. The colourability of these graphs is analysed using Boolean satisfiability (SAT) solvers. Finally, this thesis shows that similar methods are applicable in capturing the existence of distributed algorithms for other graph problems, such as the maximal matching problem.

Accurate mass-based analysis in human sport doping control : Application of liquid chromatography - time-of-flight mass spectrometry

Human sport doping control analysis is a complex and challenging task for anti-doping laboratories. The List of Prohibited Substances and Methods, updated annually by World Anti-Doping Agency (WADA), consists of hundreds of chemically and pharmacologically different low and high molecular weight compounds. This poses a considerable challenge for laboratories to analyze for them all in a limited amount of time from a limited sample aliquot. The continuous expansion of the Prohibited List obliges laboratories to keep their analytical methods updated and to research new available methodologies. In this thesis, an accurate mass-based analysis employing liquid chromatography - time-of-flight mass spectrometry (LC-TOFMS) was developed and validated to improve the power of doping control analysis. New analytical methods were developed utilizing the high mass accuracy and high information content obtained by TOFMS to generate comprehensive and generic screening procedures. The suitability of LC-TOFMS for comprehensive screening was demonstrated for the first time in the field with mass accuracies better than 1 mDa. Further attention was given to generic sample preparation, an essential part of screening analysis, to rationalize the whole work flow and minimize the need for several separate sample preparation methods. Utilizing both positive and negative ionization allowed the detection of almost 200 prohibited substances. Automatic data processing produced a Microsoft Excel based report highlighting the entries fulfilling the criteria of the reverse data base search (retention time (RT), mass accuracy, isotope match). The quantitative performance of LC-TOFMS was demonstrated with morphine, codeine and their intact glucuronide conjugates. After a straightforward sample preparation the compounds were analyzed directly without the need for hydrolysis, solvent transfer, evaporation or reconstitution. The hydrophilic interaction technique (HILIC) provided good chromatographic separation, which was critical for the morphine glucuronide isomers. A wide linear range (50-5000 ng/ml) with good precision (RSD<10%) and accuracy (±10%) was obtained, showing comparable or better performance to other methods used. In-source collision-induced dissociation (ISCID) allowed confirmation analysis with three diagnostic ions with a median mass accuracy of 1.08 mDa and repeatable ion ratios fulfilling WADA s identification criteria. The suitability of LC-TOFMS for screening of high molecular weight doping agents was demonstrated with plasma volume expanders (PVE), namely dextran and hydroxyethylstarch (HES). Specificity of the assay was improved, since interfering matrix compounds were removed by size exclusion chromatography (SEC). ISCID produced three characteristic ions with an excellent mean mass accuracy of 0.82 mDa at physiological concentration levels. In summary, by combining TOFMS with a proper sample preparation and chromatographic separation, the technique can be utilized extensively in doping control laboratories for comprehensive screening of chemically different low and high molecular weight compounds, for quantification of threshold substances and even for confirmation. LC-TOFMS rationalized the work flow in doping control laboratories by simplifying the screening scheme, expediting reporting and minimizing the analysis costs. Therefore LC-TOFMS can be exploited widely in doping control, and the need for several separate analysis techniques is reduced.

Tandemmassaspektrometrinen menetelmä neutraalien isomeeristen oligosakkaridien rakenteen määrittämisessä

Tutkimuksen tavoitteena oli ottaa käyttöön tandemmassaspektrometrinen (MS/MS) menetelmä, jolla voidaan analysoida polysakkarideista purkautuneiden oligosakkaridien rakenteita. Tavoitteena oli, että menetelmällä voidaan määrittää glykosidisten sidosten eri asemat monosakkaridirakenteiltaan samanlaisista neutraaleista lineaarisista oligosakkarideista. Kirjallisuustutkimuksessa tarkasteltiin oligosakkaridien rakenteiden määrittämiseen käytettyjä MS/MS-menetelmiä ja oligosakkaridien pilkkoutumisreaktioita MS/MS-analyysissa. Kirjallisuuden perusteella MS/MS-analyysissa oligosakkaridien pilkkoutuminen voi tapahtua joko glykosidisen sidoksen katkeamisella tai monosakkaridirenkaan halkeamisella. Monosakkaridirenkaan pilkkoutumisesta muodostuvia tuoteioneja voidaan käyttää glykosidisen sidoksen aseman määrittämiseen. Kokeellisessa tutkimuksessa selvitettiin aluksi monosakkaridirakenteiltaan isomeerisilla disakkaridimalliaineilla glykosidisen sidoksen sijainnin vaikutus disakkaridin pilkkoutumiseen MS/MS-analyysissa. Tämän jälkeen pyrittiin löytämään tunnetuista tri- ja tetrasakkaridimalliaineista näitä eri sidoksille tyypillisiä tuoteionien jakaumia. Tunnettujen tri- ja tetrasakkaridien pilkkoutuminen yhdenmukaisesti disakkaridien pilkkoutumisen kanssa antaisi mahdollisuuden pitkäketjuisempien oligosakkaridien glykosidisten sidosten tunnistamiseen sovelletulla MS/MS-menetelmällä. MS/MS-analyysit tehtiin ioniloukkumassadetektorilaitteistolla käyttäen sähkösumutusionisaatiota (ESI). Oligosakkaridit määritettiin positiivisella ionisaatiolla litium- ja natriumaddukti-ioneina ja negatiivisella ionisaatiolla kloridiaddukti-ioneina. Vertaamalla tri- ja tetrasakkarideista MS/MS-analyyseissa muodostuneita tuoteioneja disakkarideista muodostuneisiin tuoteioneihin, voitiin sekä positiivisella että negatiivisella ionisaatiolla määrittää oligosakkaridin pelkistävän pään sidoksen asema. Negatiivisella ionisaatiolla tri- ja tetrasakkarideista muodostuneista tuoteioneista voitiin määrittää myös muiden kuin pelkistävän pään sidosten asemia. Positiivisella ionisaatiolla muiden sidosten määrittäminen ei ollut mahdollista, koska rengasfragmentti-ioneja muodostui pääosin oligosakkaridin pelkistävästä päästä. Glykosidisen sidoksen katkeamisesta muodostuneet tuoteionit analysoitiin edelleen MS3-analyysilla. MS3-analyysissa muodostuneista tuoteioneista ei voitu tulkita sidosten asemia, koska lähtöionit koostuivat sekä terminaalisen että pelkistävän pään isomeerisista ioneista.