Surgical treatment of hamstring injuries and disorders – the clinical spectrum from chronic tendinopathy to complete rupture

Hamstring muscle injuries and tendon disorders are common, especially in sports. They can be severe and difficult to treat, often resulting in impaired athletic performance and long rehabilitation times. Previous studies considering treatment of these problems are scarce. The current study was designed to investigate the effect of surgery on different types of hamstring muscle injuries and on proximal hamstring tendinopathy. In addition, we wanted to study the typical histopathological findings relating to proximal hamstring tendinopathy. In the study of complete (all three muscles torn) proximal hamstring avulsions (41 patients), our results showed that early operative treatment gives significantly better results than late surgery, and is therefore recommended. Despite this, considerable improvement of symptoms could also be achieved in chronic cases. In the study of partial (one or two muscles torn) proximal hamstring tears (47 patients), we observed that these injuries can cause significant functional deficit and impaired performance in athletes. The main finding was that after surgical repair most of the patients were able to return to their pre-injury level of sports. In the study of distal hamstring tears (18 patients), the results showed that surgical treatment had a good effect in the majority of these cases. In proximal hamstring tendinopathy, the main problem is pain which limits sports. In this study (90 patients), we found that after unsuccessful conservative treatment, surgery was a good treatment option resulting in full return to sports in most cases. In tendinopathic hamstring tendons, the morphological changes of tendinosis were largely identical to those previously described in other common (e.g. Achilles and patellar) tendinopathies. In chronic proximal hamstring avulsions, and also in reoperations, a large defect between distally retracted tendons and the ischial tuberosity may occasionally prevent anatomic reinsertion. We have described a reconstruction method using fascia lata autograft augmentation to be used in these most challenging repairs. This technique was utilized in the treatment of five patients, with encouraging results.

Structural development of the harvester head saw unit

The main goal of the thesis was to further develop harvester head saw device to the Finnish forest machine manufacturer. The work was done from the basis of the manufacturer´s current production model and the earlier study from this same subject called: “Development of chain saw for harvester” Tero Kaatrasalo, 2004. The work was focused to improving the serviceability and reliability of the saw device, but design also included adding few beforehand determined new features into the saw unit. This was done to give some added value for the end customer. The work includes analysis of the earlier saw devices and ideations of the improvements for the structure.

Targeting Adenoviral Gene Therapy Vectors to Head and Neck Squamous Cell Carcinoma and Heart

Gene therapy aims to treat diseases by introducing genetic material to the diseased tissue. For cancer treatment it is important to destroy cancerous cells; this can be achieved by introducing a gene, which induces cell death or by allowing viral vectors to replicate, which also results in destruction of cancerous cells. For cardiac diseases the approach is more like the former, except the gene produces beneficial effects, like angiogenesis. Adenoviruses have many beneficial qualities, which make the virus an interesting gene therapy vector; it can be produced relatively easily, its manipulation is quite easy and it has naturally broad tropism. By removing or replacing certain genes in the adenoviral genome, it can be made non-replicative. In this study, adenoviral receptor expression patterns were characterized in both head and neck squamous cell carcinoma and the human heart. Adenovirus serotype 5 receptor expression in head and neck cancer cell lines was found to be highly variable between cell lines and overall at lower levels, while Ad35 receptor expression was more uniform and at higher levels in all analyzed cell lines. It was also shown that a hybrid virus Ad5/35 is able to infect cells refractory to Ad5, which correlates with receptor expression in these cells. Furthermore, this difference in infection properties extends to cell killing efficiency in case of conditionally replicative viruses. Expression levels of adenoviral receptors CAR, CD46, CD86 and αv-integrins were found to be high both in normal and dilated cardiomyopathy heart tissue. The receptor levels also correlate with transduction efficiency after intracardiac injection. Ad5 showed superior transduction ability compared with Ad5/35, but evoked also a more profound immune reaction when administered this way. Adenoviral gene therapy vectors are the most used delivery vehicles in clinical trials to date. These vectors have proven to be well tolerated and positive results have been obtained when combined with traditional treatments, although poor transduction efficiency has often been reported due to low-level expression of viral receptors on target cells. In spite of this, the results are encouraging and merit for further research.

Analyzing hydraulic head of fluid flow in underground porous medium

Hydraulic head is distributed through a medium with porous aspect. The analysis of hydraulic head from one point to another is used by the Richard's equation. This equation is equivalent to the groundwater ow equation that predicts the volumetric water contents. COMSOL 3.5 is used for computation applying Richard's equation. A rectangle of 100 meters of length and 10 meters of large (depth) with 0,1 m/s fl ux of inlet as source of our fl uid is simulated. The domain have Richards' equation model in two dimension (2D). Hydraulic head increases proportional with moisture content.

Differentiation of Metabolically Distinct Areas within Head and Neck Region using Dynamic 18F-FDG Positron Emission Tomography Imaging

Positron Emission Tomography (PET) using ¹⁸F-FDG is playing a vital role in the diagnosis and treatment planning of cancer. However, the most widely used radiotracer, ¹⁸F-FDG, is not specific for tumours and can also accumulate in inflammatory lesions as well as normal physiologically active tissues making diagnosis and treatment planning complicated for the physicians. Malignant, inflammatory and normal tissues are known to have different pathways for glucose metabolism which could possibly be evident from different characteristics of the time activity curves from a dynamic PET acquisition protocol. Therefore, we aimed to develop new image analysis methods, for PET scans of the head and neck region, which could differentiate between inflammation, tumour and normal tissues using this functional information within these radiotracer uptake areas. We developed different dynamic features from the time activity curves of voxels in these areas and compared them with the widely used static parameter, SUV, using Gaussian Mixture Model algorithm as well as K-means algorithm in order to assess their effectiveness in discriminating metabolically different areas. Moreover, we also correlated dynamic features with other clinical metrics obtained independently of PET imaging. The results show that some of the developed features can prove to be useful in differentiating tumour tissues from inflammatory regions and some dynamic features also provide positive correlations with clinical metrics. If these proposed methods are further explored then they can prove to be useful in reducing false positive tumour detections and developing real world applications for tumour diagnosis and contouring.

Epidemiology, management and outcome of facial injuries

Dental injuries are common and the incidence of maxillofacial injuries has increased over the recent decades in Finland. Accidental injuries are the global leading cause of death among children over the age of one year and among adults under the age of 40 globally. Significant resources and costs are needed for the treatment of these patients. The prevention is the most economical way to reduce trauma rates and costs. For the prevention it is crucial to know the prevalences, incidences and risk factors related to injuries. To improve the quality of treatment, it is essential to explore the causes, trauma mechanisms and management of trauma. The above mentioned was the aim of this thesis. With a large epidemiological cohort study (5737 participants) it was possible to estimate lifetime prevalence of and risk factors for dental trauma in general population (Study I). The prevalence of dental fractures was 43% and the prevalence of dental luxations and avulsions was 14%. Male gender, a history of previous non-dental injuries, mental distress, overweight and high alcohol consumption were positively associated with the occurrence of dental injuries Study II was conducted to explore the differences in type and multiplicity of mandibular fractures in three different countries (Canada, Finland and Kuwait). This retrospective study showed that the differences in mandibular fracture multiplicity and location are based on different etiologies and demographic patterns. This data can be exploited for planning of measures to prevent traumatic facial fractures. The etiology, management and outcome of 63 pediatric skull base fracture (Study III) and 20 pediatric frontobasal fracture patients (Study IV) were explored. These retrospective studies showed that, both skull base fracture and frontobasa fracture are rare injuries in childhood and although intracranial injuries and morbidity are frequent, permanent neurological or neuropsychological deficits are infrequent. A systematic algorithm (Study V) for computer tomography (CT) image review was aimed at clinicians and radiologists to improve the assessment of patients with complex upper midface and cranial base trauma. The cohort study was cross sectional and data was collected in the Turku and Oulu University Hospitals. A novel image-reviewing algorithm was created to enhance the specificity of CT for the diagnosis of frontobasal fractures. The study showed that an image-viewing algorithm standardizes the frontobasal trauma detection procedure and leads to better control and assessment. The purpose of the retrospective subcranial craniotomy study (VI) was to review the types of frontobasal fractures and their management, complications and outcome when the fracture is approached subcranially. The subcranial approach appears to be successful and have a reasonably low complication rate. It may be recommended as the technique of choice in multiple and the most complicated frontal base fractures where the endoscopic endonasal approach is not feasible.

Extending the Hydra Head to Create a Pluggable, Extensible Architecture: Diving into the Technology of Hydramata

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

UG2-päivitetyn Hawkin Head-Up Displayn toiminta

UG2-päivitys korvasi vanhan Hawkin mittareita nykyaikaisella Head-Up Displaylla. Tutkielmassa selvitetään kuinka UG2-päivitetyn Hawkin Head-Up Display toimii. Tämä selvitetään tutustumalla laitteen tekniseen toimintaan sekä selvittämällä mitä merkkejä ja arvoja HUD:illa esitetään eri tilanteissa. UG2-päivitys mahdollistaa jatkossa HUD:in merkkien päivittämisen helposti tietokoneen avulla, eikä laitteita tarvitse vaihtaa. Tutkimus on kvalitatiivinen, ja siinä tehdään deskriptiivinen tutkimus yhden laitteen toiminnasta. Tärkeimpinä lähteinä käytetään ilmavoimien omaa materiaalia koskien kyseistä päivitystä ja ohjaajan koulutukseen käytettävää Air Crew Manual (ACM) -ohjekirjaa. Ulkopuolisista lähteistä on selvitetty laitteen teknistä toimintaa ja arvojen sijoitteluun sovittuja sääntöjä ja normeja. Tutkielmassa selviää, että HUD on ensisijaisesti käytettävä näyttö, joka siirtää ohjaajan katseen ulos ohjaamosta. Tekniikka luo haasteita näyttölaitteen koolle, koska arvot heijastetaan ja tarkennetaan äärettömään, luoden ohjaajalle vain pienen kohdan, jossa arvot näkyvät. Merkkien sijainti noudattaa Basic-T -mallia, jolla analogisten mittareiden helppolukuisuus on siirretty HUD:ille. Tutkimuksen mukaan merkkien tulee myös sijaita lähellä toisiaan. Tutkielman johtopäätökset rakentuvat koneiden ja laitteiden yhteensopivuuden ympärille. HUD siirtää ohjaajan katseen ulos koneesta, joten se tuo lisää koulutusmahdollisuuksia. Poistamalla tietoja HUD:ilta lennon aikana, joutuisi ohjaaja tukeutumaan muihin arvoihin ja näköönsä, näin parantaen tilannetietoisuutta. Tämä parantaisi ohjaajan toimintaa kaikissa koneissa, varsinkin laitteiden vikatilanteissa. Lisäksi HUD:in merkit olisi sovitettava yhteen sähköisten varamittareiden, Hawkissa BFI:n kanssa, jotta siitä saataisiin ”mini-HUD”.