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Jäljen jäljillä : Gianni Vattimo - metafysiikan kuoleman ja kristinuskon paluun filosofi

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First-Line Chemotherapy with Anthracycline and Taxane Combination in Metastatic Breast Cancer. Detection of bone metastases with TRACP 5b

Background: In Finland, breast cancer (BC) is the most common cancer among women, and prostate cancer (PC) that among men. At the metastatic stage both cancers remain essentially incurable. The goals of therapy include palliation of symptoms, improvement or maintenance of quality of life (QoL), delay of disease progression, and prolongation of survival. Balancing between efficacy and toxicity is the major challenge. With increasing costs of new treatments, appropriate use of resources is paramount. When new treatment regimes are introduced into clinical practice a comprehensive assessment of clinical benefit, adverse effects and cost is necessary. Both BC and PC show a predilection to metastasize to bone. Bone metastases cause significant morbidity impairing the patients´ QoL. Diagnosis of bone metastases relies mainly on radiological methods, which however lack optimal sensitivity and specificity. New tools are needed for detection and follow-up of bone metastases. Aims: Anthracyclines and taxanes are effective chemotherapeutic agents in the treatment of metastatic breast cancer (MBC) with different mechanisms of action. Therefore, evaluation of the combination of anthracyclines with taxanes was a justifiable approach in the treatment of MBC patients. We assessed the efficacy, toxicity, cost of treatment and QoL of BC patients treated with first-line chemotherapy for metastatic disease with the combination epirubicin and docetaxel. We also evaluated the diagnostic potential of tartrate-resistant acid phosphatase 5b (TRACP 5b) and carboxyterminal telopeptides of type I collagen (ICTP) in the diagnosis of bone metastases in BC and TRACP 5b in PC patients. Results: The combination of epirubicin and docetaxel was effective in this phase II study, but required individual dose adjustment to avoid neutropenic infections, and the use of growth factors to maintain a feasible dose level. The response rate was 54 % (95 % CI 37-71) and the median overall survival (OS) was 26 months. Of the patients, 87 % were treated for infections. The treatment of adverse events required additional use of health resources mainly due to neutropenic infections, thereby raising direct treatment costs by 20 %. Despite adverse events, the global QoL was not significantly compromised during the treatment. Clinically evident acute cardiac toxicity was not observed. The combination of serum TRACP 5b and ICTP was at least equally sensitive and specific in detection of of bone metastases as commonly used total alkaline phosphatise (tALP) in BC patients. In contrast, TRACP 5b was less specific and sensitive than tALP as a marker of skeletal changes in PC patients. Conclusions: Treatment with epirubicin and docetaxel showed high efficacy in first-line chemotherapy of MBC. The relatively high incidence of neutropenic infections requiring hospitalization increased the treatment costs. Despite adverse events, the global QoL of the patients was not significantly compromised. The combination of TRACP 5b and ICTP showed similar activity as tALP in detecting bone metastases in MBC. In contrast, TRACP 5b was less specific and sensitive than tALP as a marker of skeletal changes in PC.

Organisaatioiden ostokäyttäytyminen yliopistollisen aikuiskoulutuksen hankinnassa

Tutkimuksen toimeksiantaja on Lappeenrannan teknillisen yliopiston Koulutus- ja kehittämiskeskus. Tutkimuksen tavoitteena on selvittää miten yliopiston asiakasorganisaatioiden hankintapäätös muodostuu. Pääpaino tutkimuksessa on päätöksentekoyksikön ja päätöksentekokriteerien kartoittamisessa. Teoriaosuus koostuu työn kannalta keskeisimmistä aikuiskoulutuspalveluiden sekä organisaation ostokäyttäytymisen teorioista. Tutkimuksessa käytetään sekä kvalitatiivisia, että kvantitatiivisia tutkimusmenetelmiä. Pääpaino on haastattelututkimuksella ja aineisto analysoidaan laadullisin menetelmin. Otanta koostuu kahdeksasta asiakasorganisaatiosta ja kahdeksasta organisaatiosta, joiden kanssa toivotaan yhteistyötä. Yritykset ovat toimeksiantajan asiakasmatriisista. Tutkimuksen perusteella saatiin selkeä kuva yritysten koulutuksen hankinnasta. Henkilöstön kouluttaminen koetaan yrityksissä tärkeäksi ja siihen panostetaan paljon. Merkittävästi päätöksentekoon yrityksessä ottavat osaa koulutusvastaava ja henkilöstöhallinto. Päätös muodostetaan yhteistyössä asiantuntijan kanssa, joka on usein liiketoimintayksikön esimies. Merkittävimmät päätöksentekoon vaikuttavat kriteerit selkiytyivät koulutuksen tarjoajan, koulutuksen sekä hankintaprosessin osalta sekä asiakasorganisaatioissa että potentiaalisissa yrityksissä. Vaikka tutkimustulosten ja toimenpide-ehdotusten raportointi tapahtuu tässä tutkimuksessa yleisellä tasolla, saa Koulutus- ja kehittämiskeskus tutkimuksen konkreettiset tulokset kuten kontaktoitavat henkilöt, päätöksentekoyksikön jäsenet sekä päätöksentekokriteerit kussakin yrityksessä omaan yksityiseen käyttöönsä. Päätöksentekokriteerit ovat hyödyksi erityisesti toivottavien potentiaalisten organisaatioiden vaatimusten ymmärtämisessä.

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Myöhäinen pakkasvarastoinnin päättäminen lisää kuusentaimien pakkasvaurioriskiä syksyllä

Seloste artikkelista: Hänninen, H., Luoranen, J., Rikala, R. and Smolander, H. 2009. Late termination of freezer storage increases the risk of autumn frost damage to Norway spruce seedlings. Silva Fennica 43 (5) : 817–830.

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Kestävä ikääntyminen

Jyväskylän yliopiston Ikääntymisen tutkimuksen foorumi 9.12.2010.

Mild Cognitive Impairment and Early Detection of Alzheimer`s Disease. A Positron Emission Tomography Study

Alzheimer`s disease (AD) is characterised neuropathologically by the presence of extracellular amyloid plaques, intraneuronal neurofibrillary tangles, and cerebral neuronal loss. The pathological changes in AD are believed to start even decades before clinical symptoms are detectable. AD gradually affects episodic memory, cognition, behaviour and the ability to perform everyday activities. Mild cognitive impairment (MCI) represents a transitional state between normal aging and dementia disorders, especially AD. The predictive accuracy of the current and commonly used MCI criteria devide this disorder into amnestic (aMCI) and non-amnestic (naMCI) MCI. It seems that many individuals with aMCI tend to convert to AD. However many MCI individuals will remain stable and some may even recover. At present, the principal drugs for the treatment of AD provide only symptomatic and palliative benefits. Safe and effective mechanism-based therapies are needed for this devastating neurodegenerative disease of later life. In conjunction with the development of new therapeutic drugs, tools for early detection of AD would be important. In future one of the challenges will be to detect at an early stage these MCI individuals who will convert to AD. Methods which can predict which MCI subjects will convert to AD will be much more important if the new drug candidates prove to have disease-arresting or even disease–slowing effects. These types of drugs are likely to have the best efficacy if administered in the early or even in the presymptomatic phase of the disease when the synaptic and neuronal loss has not become too widespread. There is no clinical method to determine with certainly which MCI individuals will progress to AD. However there are several methods which have been suggested as predictors of conversion to AD, e.g. increased [11C] PIB uptake, hippocampal atrophy in MRI, low CSF A beta 42 level, high CSF tau-protein level, apolipoprotein E (APOE) ε4 allele and impairment in episodic memory and executive functions. In the present study subjects with MCI appear to have significantly higher [¹¹C] PIB uptake vs healthy elderly in several brain areas including frontal cortex, the posterior cingulate, the parietal and lateral temporal cortices, putamen and caudate. Also results from this PET study indicate that over time, MCI subjects who display increased [¹¹C] PIB uptake appear to be significantly more likely to convert to AD than MCI subjects with negative [¹¹C] PIB retention. Also hippocampal atrophy seems to increase in MCI individuals clearly during the conversion to AD. In this study [¹¹C] PIB uptake increases early and changes relatively little during the AD process whereas there is progressive hippocampal atrophy during the disease. In addition to increased [¹¹C] PIB retention and hippocampal atrophy, the status of APOE ε4 allele might contribute to the conversion from MCI to AD.

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