Measurement of Bioactivity of Immunomodulatory Treatment of Relapsing Multiple Sclerosis. With Emphasis on MxA Protein

Background Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, which mainly affects young adults. In Finland, approximately 2500 out of 6000 MS patients have relapsing MS and are treated with disease modifying drugs (DMD): interferon- β (INF-β-1a or INF-β-1b) and glatiramer acetate (GA). Depending on the used IFN-β preparation, 2 % to 40 % of patients develop neutralizing antibodies (NAbs), which abolish the biological effects of IFN-β, leading to reduced clinical and MRI detected efficacy. According to the Finnish Current Care Guidelines and European Federation of Neurological Societis (EFNS) guidelines, it is suggested tomeasure the presence of NAbs during the first 24 months of IFN-β therapy. Aims The aim of this thesis was to measure the bioactivity of IFN-β therapy by focusing on the induction of MxA protein (myxovirus resistance protein A) and its correlation to neutralizing antibodies (NAb). A new MxA EIA assay was set up to offer an easier and rapid method for MxA protein detection in clinical practice. In addition, the tolerability and safety of GA were evaluated in patients who haddiscontinued IFN-β therapy due to side effects and lack of efficacy. Results NAbs developed towards the end of 12 months of treatment, and binding antibodies were detectable before or parallel with them. The titer of NAb correlated negatively with the amount of MxA protein and the mean values of preinjection MxA levels never returned to true baseline in NAb negative patients, but tended to drop in the NAb positive group. The test results between MxA EIA and flow cytometric analysis showed significant correlation. GA reduced the relapse rate and was a safe and well-tolerated therapy in IFN-β-intolerant MS patients. Conclusions NAbs inhibit the induction of MxA protein, which can be used as a surrogate marker of the bioactivity of IFN-β therapy. Compared to flow cytometricanalysis and NAb assay, MxA-EIA seemed to be a sensitive and more practical method in clinical use to measure the actual bioactivity of IFN-β treatment, which is of value also from a cost-effective perspective.

Effects of physical treatment of barley and rapeseed meal in dairy cows given grass silage-based diets

Selostus: Ohran ja rypsirouheen fysikaalisen käsittelyn vaikutus maidontuotantoon säilörehuun perustuvalla ruokinnalla

Operative Treatment of Ovarian Cancer and Borderline Tumors in Different Hospital Categories in Finland

Surgery is the cornerstone of ovarian cancer treatment and maximal cytoreduction is important. In the early 1980’s primary surgical treatment of ovarian cancer was performed in over 80 hospitals in Finland. The significance of the operative volume of the hospital, of the training of the surgeons and of centralization of surgical treatment has been widely discussed. The aim of the present study was to evaluate the outcome of surgical treatment of ovarian cancer in different hospital categories retrospectively and prospectively, and to analyze if any differences are reflected in survival. The retrospective study included 3851 ovarian cancer patients operated between 1983 and 1994 in Finland. The data was analyzed according to hospital category (university, central, and other) and by quartiles of the hospital operative volume. The results showed that patients operated in the highest operative volume hospitals had the best relative survival. When stratifying the analysis by the period of diagnosis (1983-1988 and 1989-1994), the university hospitals improved their performance the most. The prospective part of the thesis was initiated in 1999 and included 307 patients with invasive ovarian cancer and 65 patients with an ovarian borderline tumor. The baseline and 5-year surveys used a questionnaire that was filled in by the operating surgeons. For analysis of the 5-year followup data, the hospitals were divided into three categories (<10, 10-20, or >20 patients operated in 1999). The effect of the surgical volume was analyzed also as a continuous variable (1-47 operations per year). In university hospitals, pelvic lymphadenectomy was performed in 88 %, and para-aortic lymphadenectomy in 73 %, of the patients with stage I disease. The corresponding figures ranged from 11 % to 21 % in the other hospitals. For stage III ovarian cancer patients operated by gynecological oncologists, the estimated odds ratio for no macroscopic residual tumor was 3.0 times higher (95 % CI 1.2-7.5) than for those operated by general gynecologists. In the university and other hospitals 82% of the patients received platinum-based chemotherapy. Platinum + taxane combination was given to 63 % of the patients in the university and in 49 % in the other hospitals (p = 0.0763). Only a minority of the patients with tumors of borderline malignancy were staged according to recommendations, most often multiple peritoneal biopsies and omentectomy were neglected. FIGO stage, patient age, and residual tumor were independent prognostic factors of cancer-specific 5-year survival. A higher hospital operative volume was also a significant prognostic factor for better cancer-specific survival (p = 0.036) and disease-free survival (p = 0.048). In conclusion, ovarian cancer patients operated in high-volume university hospitals were more often optimally debulked and had a significantly better cancer-specific survival than patients operated in other hospitals. These results favor centralization of primary surgical treatment of ovarian cancer.

Tertiary treatment of pulp and paper mill effluents

Työn tavoitteena oli selvittää mitä käsittelyvaihtoehtoja on olemassa jäteveden puhdistamon tertiäärikäsittelyyn ja miten suuri tarve paperi- ja selluteollisuuden prosessivesien puhdistukseen on. Tarkoituksena oli saada käsitys koko tertiäärikäsittelystä eri näkökulmista. Lopuksi läpikäytiin tertiäärikäsittelymenetelmiä ja etsittiin mahdollisia uusia menetelmiä, joita voitaisiin käyttää jäteveden tertiääripuhdistukseen. Ensimmäisenä työssä on perehdytty jäteveden koostumukseen paperi- ja selluteollisuudessa ja puhdistukseen ilmastetulla aktiivilietemenetelmällä, jotta tertiäärikäsittely ymmärrettäisiin konseptina paremmin. Lisäksi työssä selvitettiin tertiäärikäsittelyn tarvetta ja vaihtoehtoja sen käyttämättä jättämiselle teollisuuden ja muun ympäristöä vahingoittavan toiminnan ympäristönäkökohdat huomioonottaen. Lyhyiden menetelmäesitysten jälkeen kiteytetään tertiäärikäsittelyn ympäristönäkökohdatja vaihtoehdot sen käytölle yhteenvetona, jossa otetaan huomioon myös viranomaisten, yrityksen ja BAT referenssien sisältämä tieto tertiäärikäsittelystä. Työn kokeellinen osa sisältää erään tertiäärikäsittelysovelluksenrakentamisen, koekäytön ja laboratorioanalyysien yhteenvedon. Lisäksi menetelmää verrataan kustannus-tehokkuudeltaan vastaavien menetelmien kanssa. Tarkoituksena oli löytää jäteveden tertiäärikäsittelyyn sopiva laitteisto, jonka toimintaanei sisältyisi kemikaalien annostelua ja sitä käytettäisiin lähinnä jätevedenpuhdistamon ongelmatilanteiden väliaikaiseksi ratkaisuksi. Mahdollisesti se voisi toimia myös jatkuvatoimisesti veden kirkastuksessa. Diplomityössä rakennettu laitteisto, jota käytettiin myös pilot koeajoissa, ei ollut paras mahdollinen laitteisto tertiäärikäsittelyn toteuttamiseksi paperi- ja selluteollisuudessa, mutta kilpailukykyinen muiden laitteistojen kanssa. Laitteiston toimintaperiaate on kuitenkin käyttökelpoinen tietyin varauksin ja sitä voidaan käyttää vedenpuhdistamiseen.

Wastewater Treatment of Diesel Power Plant

Diplomityön tavoitteena on selvittää Wärtsilän dieselvoimalaitosten jätevedenkäsittelyn vallitseva tila. Tutkimuksessa keskitytään raskaspolttoöljykäyttöisiin voimalaitoksiin. Työssä selvitetään yleisimmät dieselvoimalaitosten jätevesille asetetut vaatimukset. Selvitys tehdään keräämälläja tutkimalla dieselvoimalaitosten jätevesille sovellettuja standardeja. Työssä selvitetään myös dieselvoimalaitokselta ulostulevan jäteveden laatu sekä nykyisen jätevedenkäsittelyjärjestelmän toiminta. Selvitys tehdään keräämällä ja tutkimalla yrityksen sisäisiä tietoja, sekä ottamalla ja analysoimalla jätevesinäytteitä. Näytteiden otto ja analysointi toteutetaan vierailemallakahdessa voimalaitoksessa sekä yhdessä muussa kohteessa. Jäteveden laatu ennen ja jälkeen käsittelyn määritetään. Myös öljynjalostusteollisuuden jätevedenkäsittelyä tarkastellaan kirjallisuuteen pohjautuen. Tarkastelun tavoitteena on hankkia tietoa jätevedenkäsittelystä kohteissa, joissa jäteveden laatu vastaa dieselvoimalaitoksella syntyvää jätevettä. Vertailun vuoksi myös öljynjalostusteollisuudelle asetetuttuja jätevesistandardeja tutkitaan. Lisäksi työssä tutkitaan myös joitakin muita jätevedenkäsittelymenetelmiä. Diplomityön tuloksena määritetään dieselvoimalaitosten jätevedenkäsittelyn tulevaisuuden haasteet ja mahdollisuudet.

Choice of Optimal MembraneProcesses for Economical Treatment of Paper Machine Clear Filtrate

In this thesis membrane filtration of paper machnie clear filtrate was studied. The aim of the study was to find membrane processes which are able to produce economically water of sufficient purity from paper machine white water or its saveall clarified fractions for reuse in the paper machnie short circulation. Factors affecting membrane fouling in this application were also studied. The thesis gives an overview af experiments done on a laboratory and a pilot scale with several different membranes and membrane modules. The results were judged by the obtained flux, the fouling tendency and the permeate quality assessed with various chemical analyses. It was shown that membrane modules which used a turbulence promotor of some kind gave the highest fluexes. However, the results showed that the greater the reduction in the concentration polarisation layer caused by increased turbulence in the module, the smaller the reductions in measured substances. Out of the micro-, ultra- and nanofiltration membranes tested, only nanofiltration memebranes produced permeate whose quality was very close to that of the chemically treated raw water used as fresh water in most paper mills today and which should thus be well suited for reuse as shower water both in the wire and press section. It was also shown that a one stage nanofiltration process was more effective than processes in which micro- or ultrafiltration was used as pretreatment for nanofiltration. It was generally observed that acidic pH, high organic matter content, the presence of multivalent ions, hydrophobic membrane material and high membrane cutoff increased the fouling tendency of the membranes.

Anaerobic treatment of deinking pulp plant effluents

Anaerobic treatment as a first biological stage in wastewater treatment is nowadays a well-established technology in recycled paper processing mills using closed water circuits. Today further developed high-rate processes and especially high-tower reactors are also able to handle lower organic loads and become therefore feasible for deinking pulp plant effluents. The interest in the anaerobic method is based on a positive energy balance in form of biogas production and low biomass yield from the process. The anaerobic treatment method was researched and its suitability for the deinking pulp plant effluents was tested experimentally at Stora Enso Maxau mill. In the theory, the deinking pulp process is introduced and the effluents from the deinking process are characterized. The anaerobic treatment is brought up in depth in terms of its use for the deinking effluents, and different kind of reactor types are presented. In addition, other wastewater treatment methods are shortly introduced with the focus on tertiary treatment. Static biodegradability tests were carried out for the wastewaters both anaerobically and aerobically. Based on the results, the deinking effluents can be degraded anaerobically, and inhibition to the methanogenic bacteria was not noticed. In the aerobic static test a good performance of the existing wastewater treatment plant at Maxau mill was proved. Later on pilot trials with sequential anaerobic-aerobic treatment were carried out for the deinking effluents. The anaerobic reactor used was a so called internal circulation reactor. The results confirmed that the combination of the anaerobic treatment and the aerobic activated sludge process is a suitable method for deinking wastewaters with a COD reduction as good as with a two stage aerobic method. When combined with the outstanding quality of the produced biogas and the cost savings acquired from the lower sludge production, the anaerobic treatment was found to be an especially favorable treatment method.

Biochemical treatment of brown grade rejects in recycling process

Ruskeisiin kierrätysmassoihin kuuluu kulutuksen kannalta tärkeimpänä laatuna OCC (old corrugated containers). OCC sisältää noin 70-100% aaltopahvia eli pääasiassa se koostuu valkaisemattomasta kemiallisesta massasta. OCC uusiomassan ensisijainen käyttökohde on aaltopahvin valmistus. OCC:n kierrätyskuituprosessissa syntyy merkittäviä määriä rejektiä. Rejektin määrä riippuu paljolti kierrätettävän materiaalin laadusta ja puhtaudesta, mutta myös tulevan massan käyttötarkoituksesta sekä prosessiolosuhteista. OCC-prosessissa rejektoituvan aineksen määrä voi nousta korkeaksi, mikäli kierrätettävä materiaali sisältää märkälujaliimoja tai muuten raskaasti liimattuja komponentteja sekä runsaasti kontaminantteja, kuten muoveja, teippejä ja metalleja. Keskimäärin OCC-rejekti sisältää 30-60% kiinteää ainesta, 30-90% (kuivapaino) kuituja, 5-70% (kuivapaino) muoveja ja 1-10% (kuivapaino) tuhkaa. Syntynyt rejekti voidaan polttaa energiaksi tai käyttää maantäyttöaineena. Harvinaisempia sovelluksia rejektin käsittelyssä ovat rejektin kuitujen talteenotto uudelleenprosessointia varten tai alkoholin ja levuliinihapon tuottamiseen. Rejektin asianmukaisella käsittelyllä voidaan vähentää kaatopaikkakustannuksia, sekä parantaa kierrätysprosessin tuottavuutta. Tämän työn tarkoituksena oli tutkia biokemiallisen käsittelyn mahdollisuudet OCC-rejektin hajotuksessa. Alustavissa laboratoriomittakaavan kokeissa etsittiin sopiva käsittelytapa, joka toteutettiin sitten pilot plant -mittakaavassa. Tulokset osoittavat, että biokemiallisen käsittelyn avulla rejekti voidaan hajottaa jolloin jätteenkäsittelykustannukset pienenevät ja kierrätyskuituprosessin taloudellisuus paranee.

Regenerated cellulose ultrafiltration membranes in the treatment of pulp and paper mill process waters

Ultrafiltration (UF) is widely applied in different separation processes in the pulp and paper industry. The growing need to protect the environment, a lack of pure water and an interest in producing high-value chemicals from compounds present in process waters will probably lead to an increase in the use of UF in the pulp and paper industry. The efficiency and cost-effectiveness of a UF process depends on the applied membrane. The membrane should have a high and stable filtration capacity, a particular selectivity and a long operational lifetime. To meet these requirements a membrane should have a low fouling tendency. In addition, it should withstand the prevailing operational and chemical conditions. This thesis evaluates the performance and applicability of the regenerated cellulose (RC) membranes 00030T and C2 in the treatment of pulp and paper mill process waters based on the requirements above. The results demonstrated that both the tested RC membranes fulfilled well the requirement of high filtration capacity. In addition, in the filtration of a paper mill clear filtrate (CF) the RC membranes were not as greatly affected by variations in the CF quality as a polysulphone membrane. Furthermore, due to their extreme hydrophilicity and weak charge the fouling tendency of the membranes can be expected to be low in pulp and paper mill filtration applications. It is, however, known that fouling cannot be totally avoided even when the membrane is chosen very carefully. This study indicated that carbohydrates influenced negatively on permeability and caused fouling in the filtration of groundwood mill circulation water. Thus, a pre-treatment effectively reducing the amount of carbohydrates might help to maintain a stable capacity. However, the results of the thesis also showed that the removal of some of the possible foulants might just increase the harmful effect of others. Multivariate examination was useful in the understanding of the complicated factors causing the unstable capacity. The thesis also revealed that the 00030T and C2 membranes can be used at high pressure (max. tested pressure 12 bar). The C2 membrane, having a sponge-like substructure, was more pressure resistant, and its performance was more stable at high pressure compared to the UCO30T membrane containing macrovoids in its substructure. Both tested membranes can, according to the results, also be used at temperatures as high as 70°C in acidic, neutral and alkaline conditions. However, the use at extreme conditions might cause faster ageing of the membranes compared to ageing in neutral conditions. The thesis proved that both the tested RC membranes are very suitable for pulp and paper mill applications and that the membranes can be utilised in processes operating in challenging conditions. Thus, they could be used in more demanding applications than supposed earlier.

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.

Treatment of oily wastewater by ultrafiltration: The effect of different operating and solution conditions

In many industries, such as petroleum production, and the petrochemical, metal, food and cosmetics industries, wastewaters containing an emulsion of oil in water are often produced. The emulsions consist of water (up to 90%), oils (mineral, animal, vegetable and synthetic), surfactants and other contaminates. In view of its toxic nature and its deleterious effects on the surrounding environment (soil, water) such wastewater needs to be treated before release into natural water ways. Membrane-based processes have successfully been applied in industrial applications and are considered as possible candidates for the treatment of oily wastewaters. Easy operation, lower cost, and in some cases, the ability to reduce contaminants below existing pollution limits are the main advantages of these systems. The main drawback of membranes is flux decline due tofouling and concentration polarisation. The complexity of oil-containing systems demands complementary studies on issues related to the mitigation of fouling and concentration polarisation in membranebased ultrafiltration. In this thesis the effect of different operating conditions (factors) on ultrafiltration of oily water is studied. Important factors are normally correlated and, therefore, their effect should be studied simultaneously. This work uses a novel approach to study different operating conditions, like pressure, flow velocity, and temperature, and solution properties, like oil concentration (cutting oil, diesel, kerosene), pH, and salt concentration (CaCl2 and NaCl)) in the ultrafiltration of oily water, simultaneously and in a systematic way using an experimental design approach. A hypothesis is developed to describe the interaction between the oil drops, salt and the membrane surface. The optimum conditions for ultrafiltration and the contribution of each factor in the ultrafiltration of oily water are evaluated. It is found that the effect on permeate flux of the various factors studied strongly depended on the type of oil, the type of membrane and the amount of salts. The thesis demonstrates that a system containing oil is very complex, and that fouling and flux decline can be observed even at very low pressures. This means that only the weak form of the critical flux exists for such systems. The cleaning of the fouled membranes and the influence of different parameters (flow velocity, temperature, time, pressure, and chemical concentration (SDS, NaOH)) were evaluated in this study. It was observed that fouling, and consequently cleaning, behaved differently for the studied membranes. Of the membranes studied, the membrane with the lowest propensity for fouling and the most easily cleaned was the regenerated cellulose membrane (C100H). In order to get more information about the interaction between the membrane and the components of the emulsion, a streaming potential study was performed on the membrane. The experiments were carried out at different pH and oil concentration. It was seen that oily water changed the surface charge of the membrane significantly. The surface charge and the streaming potential during different stages of filtration were measured and analysed being a new method for fouling of oil in this thesis. The surface charge varied in different stages of filtration. It was found that the surface charge of a cleaned membrane was not the same as initially; however, the permeability was equal to that of a virgin membrane. The effect of filtration mode was studied by performing the filtration in both cross-flow and deadend mode. The effect of salt on performance was considered in both studies. It was found that salt decreased the permeate flux even at low concentration. To test the effect of hydrophilicity change, the commercial membranes used in this thesis were modified by grafting (PNIPAAm) on their surfaces. A new technique (corona treatment) was used for this modification. The effect of modification on permeate flux and retention was evaluated. The modified membranes changed their pore size around 33oC resulting in different retention and permeability. The obtained results in this thesis can be applied to optimise the operation of a membrane plant under normal or shock conditions or to modify the process such that it becomes more efficient or effective.

Surgical Treatment of Colorectal Cancer. Controversial Issues

Aims: This study was carried out to evaluate surgical treatment of colorectal cancer (CRC) with special interest in present status and controversial issues: stenting as a palliative procedure for metastasized CRC (I), duration of thromboprophylaxis after the surgical treatment of CRC (II), treatment of the increasing population of elderly people (III) and the quality of life (QoL) after surgery for rectal cancer with special reference to pelvic floor dysfunction (IV). Materials and methods: The material consisted of patients with CRC operated on at Turku University Hospital between 2003 and 2008. In study II the data was collected retrospectively from electronic archives. In other studies the follow-up data was collected at postoperative control visits. In study IV the RAND-36 standardized questionnaire and additional questions assessing urinary, sexual and anorectal dysfunction were used. Results: The results of the current study showed that self-expanding metallic stents provided an alternative to palliative surgery in the treatment of obstructive CRC. Low molecular heparin given s.c. for a median of 11 days until hospital discharge seemed to provide sufficient thromboprophylaxis after surgery. With preoperative selection elderly patients with rectal cancer were suitable for major surgery for rectal cancer with morbidity and mortality rates comparable to those in younger patients. There was no difference between preoperative and one year postoperative general QoL for operated rectal cancer patients. Postoperative pelvic dysfunction was associated with an impaired QoL in some dimensions. Conclusions: Many individual factors regarding the patient and the disease must be taken into account when making treatment decisions in CRC to ensure successful treatment of CRC, patient satisfaction and QoL.

The oxygenation in biological wastewater treatment of pulp and paper industry

The UPM-Kymmene Oyj Pietarsaari pulp and paper Mill biological wastewater treatment plant was built in the 1980's and the plant has been in use ever since. During the past years there have been problems with deviations. The wastewater treatment plant needs update, especially the aeration basin, where the old surface aerators cannot produce enough mixing and indroduce oxygen enough to the wastewater. In this thesis how extra aeration with oxygen affects the wastewater treatment plant effluent was studied. In the literature part the main focus is in aeration devices, which can be used in biological wastewater treatment. The target is to compare different kind of aerators, which are suitable for pulp and paper wastewater treatment. Studies show, that EDI-aerators are commonly used and also most suitable. In the experimental part, the focus is on the Pietarsaari Mills wastewater treatment plant and oxygen aeration during autumn 2008. This thesis presents the results of the trial run. Studies show, that extra oxygen devices can produce lot a of mixing and the oxygenation capacity was more than what the micro-organisms needed. The effect on sludge quality could not been seen during the trial runs.