Molecular mechanisms of cancer predisposition in HNPCC/Lynch syndrome

Hereditary non-polyposis colorectal carcinoma (HNPCC; Lynch syndrome) is among the most common hereditary cancers in man and a model of cancers arising through deficient DNA mismatch repair (MMR). It is inherited in a dominant manner with predisposing germline mutations in the MMR genes, mainly MLH1, MSH2, MSH6 and PMS2. Both copies of the MMR gene need to be inactivated for cancer development. Since Lynch syndrome family members are born with one defective copy of one of the MMR genes in their germline, they only need to acquire a so called second hit to inactivate the MMR gene. Hence, they usually develop cancer at an early age. MMR gene inactivation leads to accumulation of mutations particularly in short repeat tracts, known as microsatellites, causing microsatellite instability (MSI). MSI is the hallmark of Lynch syndrome tumors, but is present in approximately 15% of sporadic tumors as well. There are several possible mechanisms of somatic inactivation (i.e. the second hit ) of MMR genes, for instance deletion of the wild-type copy, leading to loss of heterozygosity (LOH), methylation of promoter regions necessary for gene transcription, or mitotic recombination or gene conversion. In the Lynch syndrome tumors carrying germline mutations in the MMR gene, LOH was found to be the most frequent mechanism of somatic inactivation in the present study. We also studied MLH1/MSH2 deletion carriers and found that somatic mutations identical to the ones in the germline occurred frequently in colorectal cancers and were also present in extracolonic Lynch syndrome-associated tumors. Chromosome-specific marker analysis implied that gene conversion, rather than mitotic recombination or deletion of the respective gene locus accounted for wild-type inactivation. Lynch syndrome patients are predisposed to certain types of cancers, the most common ones being colorectal, endometrial and gastric cancer. Gastric cancer and uroepithelial tumors of bladder and ureter were observed to be true Lynch syndrome tumors with MMR deficiency as the driving force of tumorigenesis. Brain tumors and kidney carcinoma, on the other hand, were mostly MSS, implying the possibility of alternative routes of tumor development. These results present possible implications in clinical cancer surveillance. In about one-third of families suspected of Lynch syndrome, mutations in MMR genes are not found, and we therefore looked for alternative mechanisms of predisposition. According to our results, large genomic deletions, mainly in MSH2, and germline epimutations in MLH1, together explain a significant fraction of point mutation-negative families suspected of Lynch syndrome and are associated with characteristic clinical and family features. Our findings have important implications in the diagnosis and management of Lynch syndrome families.

Spirometric studies on the adult general population of Helsinki : bronchodilation responses, determinants, and intrasession repeatability of FEV1, FEV6, FVC, and forced expiratory time

Spirometry is the most widely used lung function test in the world. It is fundamental in diagnostic and functional evaluation of various pulmonary diseases. In the studies described in this thesis, the spirometric assessment of reversibility of bronchial obstruction, its determinants, and variation features are described in a general population sample from Helsinki, Finland. This study is a part of the FinEsS study, which is a collaborative study of clinical epidemiology of respiratory health between Finland (Fin), Estonia (Es), and Sweden (S). Asthma and chronic obstructive pulmonary disease (COPD) constitute the two major obstructive airways diseases. The prevalence of asthma has increased, with around 6% of the population in Helsinki reporting physician-diagnosed asthma. The main cause of COPD is smoking with changes in smoking habits in the population affecting its prevalence with a delay. Whereas airway obstruction in asthma is by definition reversible, COPD is characterized by fixed obstruction. Cough and sputum production, the first symptoms of COPD, are often misinterpreted for smokers cough and not recognized as first signs of a chronic illness. Therefore COPD is widely underdiagnosed. More extensive use of spirometry in primary care is advocated to focus smoking cessation interventions on populations at risk. The use of forced expiratory volume in six seconds (FEV6) instead of forced vital capacity (FVC) has been suggested to enable office spirometry to be used in earlier detection of airflow limitation. Despite being a widely accepted standard method of assessment of lung function, the methodology and interpretation of spirometry are constantly developing. In 2005, the ATS/ERS Task Force issued a joint statement which endorsed the 12% and 200 ml thresholds for significant change in forced expiratory volume in one second (FEV1) or FVC during bronchodilation testing, but included the notion that in cases where only FVC improves it should be verified that this is not caused by a longer exhalation time in post-bronchodilator spirometry. This elicited new interest in the assessment of forced expiratory time (FET), a spirometric variable not usually reported or used in assessment. In this population sample, we examined FET and found it to be on average 10.7 (SD 4.3) s and to increase with ageing and airflow limitation in spirometry. The intrasession repeatability of FET was the poorest of the spirometric variables assessed. Based on the intrasession repeatability, a limit for significant change of 3 s was suggested for FET during bronchodilation testing. FEV6 was found to perform equally well as FVC in the population and in a subgroup of subjects with airways obstruction. In the bronchodilation test, decreases were frequently observed in FEV1 and particularly in FVC. The limit of significant increase based on the 95th percentile of the population sample was 9% for FEV1 and 6% for FEV6 and FVC; these are slightly lower than the current limits for single bronchodilation tests (ATS/ERS guidelines). FEV6 was proven as a valid alternative to FVC also in the bronchodilation test and would remove the need to control duration of exhalation during the spirometric bronchodilation test.

Making sense of a transnational merger: Media texts and the (re)construction of power relations

In this study of symbolic power relations in a transnational merger, we suggest that the popular media can provide a significant arena for (re)constructing national identities and power in this kind of dramatic industrial restructuring, and are an under-utilized source of empirical data in research studies. Focusing on the press coverage of a recent Swedish-Finnish merger, we specify and illustrate a particular feature of discursive (re)construction of asymmetric power relations; superior (Swedish) and inferior (Finnish) national identities, which, we argue, are embedded in the history of colonization and domination between the two nations. The findings of the present study lead us to suggest that a lens taken from post-colonial theory is particularly useful in understanding the wider symbolic power implications of international industrial restructuring.

Deutschland, Deutschland über alles : Tysk föreningsverksamhet i Finland och Sverige 1910-1950

The voluntary associations dealt with in this dissertation were ethnic clubs and societies promoting the interests of German immigrants in Finland and Sweden. The associations were founded at the end of the 19th century as well as at the beginning of the 20th century during a time in which migration was high, the civil society grew rapidly and nationalism flourished. The work includes over 70 different associations in Finland and Sweden with a number of members ranging from ten to at most 2, 500. The largest and most important associations were situated in Helsinki and Stockholm where also most of the German immigrants lived. The main aim of this work is to explore to what extent and how the changes in government in Germany during 1910 to 1950 were reflected in the structures and participants, financial resources and meeting places, networks and activities of the German associations in Finland and Sweden. The study also deals with how a collective German national identity was created within the German associations. The period between 1910 and 1950 has been described by Hobsbawm as the apogee of nationalism. Nationalism and transnationalism are therefore key elements in the work. Additionally the research deals with theories about associations, networking and identity. The analysis is mostly based on minutes of meetings, descriptions of festivities, annual reports and historical outlines about the associations. Archival sources from the German legations, the German Foreign Office, and Finnish and Swedish officials such as the police and the Foreign Offices are also used. The study shows that the collective national identity in the associations during the Weimar Republic mostly went back to the time of the Wilhelmine Empire. It is argued that this fact, the cultural propaganda and the aims of the Weimar Republic to strengthen the contacts between Germany and the German associations abroad, and the role of the German legations and envoys finally helped the small groups of NSDAP to infiltrate, systematically coordinate and finally centralize the German associational life in Finland and Sweden. The Gleichschaltung did not go as smoothly as the party wanted, though. There was a small but consistent opposition that continued to exist in Finland until 1941 and in Sweden until 1945. The collective national identity was displayed much more in Sweden than in Finland, where the associations kept a lower profile. The reasons for the profile differences can be found in the smaller number of German immigrants in Finland and the greater German propaganda in Sweden, but also in the Finnish association act from 1919 and the changes in it during the 1920s and 1930s. Finally, the research shows how the loss of two world wars influenced the associations. It argues that 1918 made the German associations more vulnerable to influence from Germany, whereas 1945 brought the associational life back to where it once started as welfare, recreational and school associations.