Ultrastructural changes of the internal limiting membrane removed during indocyanine green assisted peeling versus conventional surgery for an idiopathic epimacular membrane

Purpose:To evaluate the histological features of cellular retinal fragments on the internal limiting membrane (ILM) removed during epiretinal membrane peeling surgery with and without the aid of ICG diluted in 5% glucose Methods:ILM specimens removed from 88 eyes undergoing vitrectomy and membrane peeling surgery for idiopathic epiretinal membrane between 1995 and 2003 were reviewed retrospectively. Surgery was performed in all cases by the same surgeon using the same technique. ICG was diluted with 5% glucose. Histological analysis focused on the presence and characteristics of retinal structures on the retinal surface of the ILM. Statistical analysis compared the results between group I (conventional surgery without ICG) and group II (ICG-assisted peeling) Results:Seventy-one eyes underwent EMM surgery without the aid of ICG (group I) and seventeen underwent EMM ICG-assisted surgery assisted using ICG (group II). The amount of Muller cell debris on the retinal surface of the ILM was more significant in the group I (no ICG) than in the group II (ICG) (40.8 versus 11.8; p = 0.024). Large fragments of Muller cells were more frequently observed in the group I (no ICG) than in the group II (ICG) (63.4% versus 23.5%; p= 0.003).The presence of larger retinal elements such as neural axons and vessels were observed attached to retinal face of the ILM in 5 (7%) cases of the no-ICG group. No such retinal elements were detected in any of the histological ILM specimens of the ICG-assisted group Conclusions:The use of ICG diluted with 5% glucose in the aid of ILM removal during epiretinal membrane surgery was associated with less retinal debris attached to retinal face of the ILM compared to surgery in which ICG was not used. Our findings contradict previous reports in the literature, in which use of ICG diluted with balanced salt solution (BSS) was associated with more retinal fragments attached to the retinal face of the ILM. According to our results, we hypothesize that diluting ICG with 5% glucose may decrease the adhesion of the ILM to the underlying retinal layers such that less retinal debris is removed with peeling of the ILM.

Surgical outcomes of deep sclerectomy versus Baerveldt aqueous shunt implantation following initial failed deep sclerectomy

Purpose: To examine the efficacy and safety of repeat deep sclerectomy (DS) versus Baerveldt shunt (BS) implantation as second line surgery following failed primary DS. Methods: Fifty one patients were prospectively recruited to undergo BS implantation following failed DS and 51 patients underwent repeat DS, for which data was collected retrospectively. All eyes had at least one failed DS. Surgical success was defined as IOP≤21mmHg and 20% reduction in IOP from baseline. Success rates, number of glaucoma medications (GMs), IOP, and complication rates were compared between the two groups at year 1, post-operatively. Results: Mean age, sex and the proportion of glaucoma subtypes were similar between groups. Preoperatively IOP was significantly lower in DS group vs BS group (18.8mmHg vs 23.8mmHg, p<0.01, two sample t-test). Postoperatively IOP was significantly higher in DS group than BS group (14.6mmHg vs 12.0mmHg, p<0.01, two-sample t-test). In the DS group, 47% of eyes did not achieve 20% reduction in IOP from baseline, as a result the success rates were significantly lower in eyes with DS (51%) than in eyes with BS (88%) (p=0.02, log-rank test). Preoperatively the number of GMs used in DS and BS groups were similar (2.2 vs 2.7 p=0.02, two sample t-test). Postoperatively there remained no significant difference in GMs between groups (0.9 vs 1.1, p= 0.58, two sample t-test). Complication rates were similar between the two groups (12% vs 10%). Conclusions: Baerveldt tube implantation was more effective in lowering IOP than repeat deep sclerectomy in eyes with failed primary DS, at year one. Complications were minor and infrequent in both groups

Epithelial Ingrowth After Lasik/altk: An Immunohistological Study Of 4 Cases. Do Epithelial Inclusions Grow From Trapped Corneal Stem-like Cells?

Purpose: To characterize the clinical, morphological and immunohistological features of epithelial ingrowth cells after laser in situ keratomileusis (LASIK) or Automated Lamellar Therapeutic Keratoplasty (ALTK) with specific reference to current markers of corneal stem cells.Methods: Four patients were included in this interventional non-comparative case series. Full ophthalmologic examination was performed. Epithelial ingrowth specimens from 4 patients were removed surgically and immunostained for cytokeratin 3 (CK3), cytokeratin 15 (CK15), cytokeratin 19 (CK19), Muc5AC, p63α, C/EBPδ, Bmi-1, BCRP/ABCG2 and Ki-67.Results: The time interval between LASIK/ALTK and ingrowth surgical removal was, 3, 11, 15 and 36 months. On slit lamp examination, early epithelial ingrowth appeared as whitish pearls and late epithelial ingrowth as confluent whitish opacities. Microscopically, the epithelial ingrowths showed features of a squamous non keratinizing epithelium. No mitotic figure was seen. Ki-67 labelling of 3 cases showed a proliferation index of 3-4%. Superficial squamous cells strongly expressed CK3. Expression of C/EBPδ, BCRP/ABCG2 and p63α was seen in more than 70% of cells and Bmi-1 was positive in up to 30% of cells in the specimens tested. There was no expression of CK19 or CK15.Conclusions: Epithelial ingrowths can persist for up to 3 years following LASIK surgery. They show a capacity for self-renewal and corneal differentiation. Besides, they express p63α, C/EBPδ, Bmi-1, BCRP/ABCG2 which have been proposed as markers of stem cell phenotype. These observations suggest that post-LASIK/ALTK epithelial inclusions could derive from stem-like cells located in the peripheral corneal epithelium.

Comparison of Fundus Autofluorescence Between Fundus Camera (Topcon) and Confocal Scanning Laser Ophthalmoscope (HRA) in Various Pathologies

Purpose: To investigate the differences between the Fundus Camera (Topcon TRC-50X) and Confocal Scanning Laser Ophthalmoscope (Heidelberg retina angiogram (HRA)) on the fundus autofluorescence (FAF) imaging (resolution and FAF characteristics). Methods: Eighty nine eyes of 46 patients with various retinal diseases underwent FAF imaging with HRA (488nm exciter / 500nm barrier filter) before fluorescein angiography (FFA) and Topcon Fundus Camera (580nm exciter / 695nm barrier filter) before and after FFA. The quality of the FAF images was estimated, compared for their resolution and analysed for the influence of fixation stability and cataracts. Hypo- and hyper-FAF behaviour was analysed for the healthy disc, healthy fovea, and a variety of pathological features. Results: HRA images were found to be of superior quality in 18 eyes, while Topcon images were estimated superior in 21 eyes. No difference was found in 50 eyes. Both poor fixation (p=0.009) and more advanced cataract (p=0.013) were found to strongly increase the likelihood of better image quality by Topcon. Images acquired by Topcon before and after FFA were identical (100%). The healthy disc was usually dark on HRA (71%), but showed mild autofluorescence on Topcon (88%). The healthy fovea showed in 100% Hypo-FAF on HRA, while Topcon showed in 52% Iso-FAF, in 43% mild Hypo-FAF, and in 5% Hypo-FAF as on HRA. No difference of FAF was found for geographic atrophy, pigment changes, and drusen, although Topcon images were often more detailed. Hyper-FAF due to exudation showed better on HRA. Pigment epithelium detachment showed identical FAF behaviour on the border, but reduced FAF with Topcon in the center. Cystic edema was visible only on HRA in a petaloid pattern. Hard exsudates caused Hypo-FAF only on HRA, hardly visible on Topcon. Blocage phenomenon by blood however was identical. Conclusions: The filter set of Topcon and the single image acquisition appear to be an advantage for patients with cataract or poor fixation. Preceding FFA does not alter the Topcon FAF image. Regarding the FAF behaviour, there are differences between the two systems which need to be taken into account when interpreting the images.

Rpe65-Gene Transfer Using an Integration-Deficient Lentiviral Vector

Purpose: We previously demonstrated efficient retinal rescue of RPE65 mouse models (Rpe65-/- (Bemelmans et al, 2006) and Rpe65R91W/R91W mice) using a HIV1-derived lentiviral vector encoding for the mouse RPE65 cDNA. In order to optimize a lentiviral vector as an alternative tool for RPE65-derived Leber Congenital Amaurosis clinical trials, we evaluated the efficiency of an integration-deficient lentiviral vector (IDLV) encoding the human RPE65 cDNA to restore retinal function in the Rpe65R91W/R91W mice. Methods: An HIV-1-derived lentiviral vector expressing either the hrGFPII or the human Rpe65 cDNA under the control of a 0.8 kb fragment of the human Rpe65 promoter (R0.8) was produced by transient transfection of 293T cells. A LQ-integrase mutant was used to generate the IDLV vectors. IDLV-R0.8-hRPE65 or hrGFPII were injected subretinally into 1 month-old Rpe65R91W/R91W mice. Functional rescue was assessed by ERG (1 and 3 months post-injection) and cone survival by immunohistology. Results: An increased light sensitivity was detected by scotopic ERG in animals injected with IDLV-R0.8-hRPE65 compared to hrGFPII-treated animals or untreated mice. However the improvement was delayed compared to integration-proficient LV and observed at 3 months but not 1 month post-injection. Immunolabelling of cone markers showed an increased number of cones in the transduced area compared to control groups. Conclusions: The IDLV-R0.8-hRPE65 vectors allow retinal improvement in the Rpe65R91W/R91W mice. Both rod function and cone survival were demonstrated even if there is a delay in the rescue as assessed by scotopic ERG. Integration-deficient vectors minimize insertional mutagenesis and thus are safer candidates for human application. Further experiments using large animals are now needed to validate correct gene transfer and expression of the RPE65 gene as well as tolerance of the vector after subretinal injection before envisaging a clinical trial application.

3D culture of postnatal retinal stem cells using self assembling polymers

PURPOSE We have previously shown that retinal stem cells (RSCs) can be isolated from the radial glia population of the newborn mouse retina (Angénieux et al., 2006). These RSCs have a great capacity to renew and to generate a large number of neurons including cells differentiated towards the photoreceptor lineage (Mehri-Soussi et al., 2006). However, recent published results from our lab revealed that such cells have a poor integration and survival rate after grafting. The uncontrolled environment of a retina seems to prevent good integration and survival after grafting in vivo. To bypass this problem, we are evaluating the possibility of generating in vitro a hemi-retinal tissue before transplantation. METHODS RSC were expanded and cells passaged <10 were seeded in a solution containing poly-ethylene-glycol (PEG) polymer based hydrogels crosslinked with peptides that are chosen to be substrates for matrix metalloproteinases. Various doses of cross linkers peptides allowing connections between PEG polymers were tested. Different growth factors were studied to stimulate cell proliferation and differentiation. RESULTS Cells survived only in the presence of EGF and FGF-2 and generated colonies with a sphere shape. No cells migrated within the gel. To improve the migration and the repartition of the cells in the gels, the integrin ligand RGDSP was added into the gel. In the presence of FGF-2 and EGF, newly formed cell clusters appeared by cell proliferation within several days, but again no outspreading of cells was observed. No difference was even seen when the stiffness of the hydrogels or the concentration of the integrin ligand RGDSP were changed. However, our preliminary results show that RSCs still form spheres when laminin is entrapped in the gel, but they started to spread out having a neuronal morphology after around 2 weeks. The neuronal population was assessed by the presence of the neuronal marker b-tubulin-III. This differentiation was achieved after successive steps of stimulations including FGF-2 and EGF, and then only FGF-2. Glial cells were also present. Further characterizations are under process. CONCLUSIONS RSC can be grown in 3D. Preliminary results show that neuronal cell phenotype acquisition can be instructed by exogenous stimulations and factors linked to the gel. Further developments are necessary to form a homogenous tissue containing retinal cells.

Maahanmuuttajaoppilaat erityiskouluissa

Immigrant Pupils in Special Education Schools The study focused on the opinions of immigrant pupils in the 1st–9th grades of basic education in four special education schools of the City of Turku and in need of special support about the following: 1. Their difficulties in going to school in general education before the transfer to a special education school. 2. Their opinions about the transfer process to special education and the changes in their school practice after being transferred to a special education school. 3. Their experiences about their school and coping in special education school. The study strengthened the idea that immigrant pupils need positive special treatment, linguistic support, individual guidance, small teaching groups and operating models that promote well-being on their integration and education path. The central educational idea of inclusive education is based on deconstructing the power structures concerning gender, ethnicity and “race” and approval of differences in the pupils. Shifting the emphasis from the pupil to working on the learning environment has resulted in special education no longer being primarily separate special education tied to a certain place, but directing the teaching more towards individuality. The central dimension of intercultural competence of a teacher working in a multicultural class seems to be the attitudes and approaches to a different pupil; the teacher must be interculturally sensitive when facing children and young people from a foreign culture. Education and teaching affect every sector of the pupil’s well-being. Learning and learning results have a connection with teaching, education and well-being. Every sector is important for the going to school and integration of an immigrant pupil in need of special support. The basis of the study is the equality of opportunities and the humanistic idea of the human being in the Finnish education policy. The immigrant pupils selected for the study represented the following language groups: Arabian, Albanian, Somali, Russian and Vietnamese. In the four special education schools, the number of immigrant pupils belonging to these language groups (2004) totalled 104. A total of 89 pupils i.e. 86% answered the questionnaire, which is sufficient considering the generalisation of the study. Although this is basically a quantitative study, the interviewing method was used in part of the study, because the questionnaires were in Finnish and consequently, it was difficult for some immigrant pupils to understand them. Understanding the questions was also affected by the fact that the age distribution in the study was very wide (7–18). According to the results of the study, the immigrants felt that the biggest drawbacks in general education were their inability to speak Finnish and lack of concentration. The actual process of being transferred to a special education class remained unclear for immigrant pupils, and they could do very little about the transfer themselves. The results show that immigrant pupils coped well in special education school; they felt that their learning ability and concentration improved in the small groups of the special education school. They considered the individual support given in the special education schools to be useful. The lower-grade immigrant pupils had a more positive attitude towards special education school than the upper-grade immigrant pupils. In all the special education schools the immigrant pupils experienced that they were in a good position in the class; girls felt this even a little more strongly than boys. The teacher-pupil-relationship was felt to be good. School bullying being so common was a negative feature experienced by immigrant pupils, who were often targets or bullies themselves. Immigrant pupils believed in their success at school and in the opportunities offered by special education schools. Generally they were of the opinion that pupils are not labelled by special school; however, upper-grade immigrant pupils were more hesitant than lower-grade immigrant pupils. This study aimed at bringing out the immigrant pupils’ own opinions. Teaching immigrant pupils in special education schools has not been very much studied in Finland, which made the topic new and even more challenging.

Selvitys yliopistorakennuksen energiatehokkuudesta

Rakennusten energiatehokkuusdirektiivi astui voimaan vuonna 2003. Yksi direktiivinkeskeisimmistä kohdista on energiatodistuksen hankkiminen silloin kun rakennusta tai sen osaa myydään tai vuokrataan. Kiinteistön omistaja voi hankkia energiatodistuksen joko erillisenä todistuksena, isännöitsijäntodistuksen osana tai katselmuksen yhteydessä. Tässä työssä verrataan jo olemassa olevaa katselmusmenettelyä erilliseen energiatodistukseen ja energiatodistuksen myöntämiseen isännöitsijätodistuksen yhteydessä case-kohteen kautta arvioituna. Vertailun suorittamiseksi tehtiin osana diplomityötä energiakatselmus Lappeenrannan teknillisen yliopiston rakennusvaiheesta 7. Energiakatselmukseen verrattuna energiatodistus on huomattavasti suppeampi selvitys rakennuksen energiankulutuksesta. Arvioitu energiankulutuksen säästöpotentiaali energiatodistuksessa oli noin puolet energiakatselmuksessa löydetyistä, kustannusten ollessa huomattavasti alhaisemmat. Erillisenä osana työssä käsitellään tilaustehojen tarkistusta Lappeenrannan teknillisen yliopiston rakennuskannasta. Rakennusvaiheen 7 tilausteho oli oikeansuuruinen, muiden rakennusvaiheiden osalta tilaustehojen uudelleen tarkastamista kannattaa harkita.

Modeling competencies and capabilities in knowledge intensive business environment

Tämän diplomityön päämääränä oli tutkia Perloksen teknologiaosaamisia. Perloksen tavoitteena on tulevaisuudessa yhdistää ja soveltaa uusia teknologioita ja älykkäitä materiaaleja muovimekaniikkaan.Ideana oli mallintaa Perloksen osaamisia ja osaamisgapeja ottaen huomioon heidän tulevaisuuden visionsa. Projektituotteena osaamisten mallintamisessa oli Perlos Healthcaren asiakkaan analysoiva mittauslaite. Tutkimuksen arvo on huomattava sillä tunnistamalla osaamisensa ja kyvykkyytensä yritys pystyy luomaan paremman tarjooman vastatessaan koko ajan kasvaviin asiakasvaatimuksiin. Tutkimus on osa TEKESin rahoittamaa LIIMA -projektia. Työn ensimmäisessä osassa esitellään osaamiseen ja partneroitumiseen liittyviä teorioita. Osaamisten mallintaminen tehtiin Excel -pohjaisella työkalulla. Se sisältää projektituotteeseen liittyen osaamisriippuvuuksien mallintamisen ja gap -analyysin. Yhtenä tutkimusmetodina käytettiin haastattelututkimusta. Työ ja sen tulokset antavat operatiivista hyötyä teknologioiden ja markkinoiden välisessä kentässä.

Kunnossapito käyttöomaisuuden arvon ja tuottokyvyn ylläpidon tukena laitoksen elinkaaren aikana

Työssä tutkittiin kunnossapidon mahdollisuuksia vaikuttaa laitoksen elinkaareen ja elinkaaren aikaisiin kustannuksiin. Lisäksi tutkittiin teknisen suunnittelun vaikutusta kunnossapidettävyyteen ja laitoksen elinkaarikustannuksiin. Työn kirjallisuusosassa on tarkasteltu nykyaikaisia kunnossapidon menetelmiä.Erityisesti on tutkittu luotettavuuskeskeistä kunnossapitoa ja kunnossapidon tehtäviä laitoksen elinkaaren aikana. Investoinnin laitevalinnoilla ja niiden suunnittelulla on myös merkittävä vaikutus käyttöön ja erityisesti kunnossapitoon. Työn empiirisessä osassa selvitettiin Botnia Mill Servicen jaMetsä - Botnian toimintamalleja Joutsenon sellutehtaalla. Erityisesti keskityttiin suuriin korjauksiin ja niiden kustannusten hallintaan. Myös kunnossapidon toimintamallia ja sen kehittämistä on tutkittu. Kokeellisessa osassa selvitettiin kunnossapidolle tyypillinen toimintamalli laitoksen elinkaaren hallintaa varten. Tehdyn selvityksen pohjalta voidaan todeta, että pitkän tähtäimen suunnittelu luo pohjaa kustannusten hallinnalle ja laitteiden kunnon ylläpidolle. Suunnittelun aikajänne tulisi olla laitteiden kunnostusten osalta vähintään kolme vuotta. Koko laitoksen kattava elinkaarisuunnitelma on hyvä laatia joheti käyttöönottovaiheen jälkeen. Pitkäjänteisellä suunnittelulla ja sen toteutuksella pystytään parhaalla mahdollisella tavalla ylläpitämään käyttöomaisuuden arvo. Kunnossapidolla on mahdollisuus vaikuttaa laitoksen käyttöomaisuuden arvonylläpitoon hallitsemalla elinkaarikustannuksia. Kunnossapidon onnistuneen toteutuksen takaa oikeanlainen johtaminen ja jatkuva osaamisen ylläpito. Myös kunnossapidossa sovitut toimintamallit ja järjestelmien jatkuva ylläpito ja kehittäminen takaavat onnistuneen toiminnan.

Sydänpuuvaltaisen erikoiskuivatun mäntysahatavaran kosteuspitoisuus kuivausjännitykset eri puuaineen tiheyksissä

Puualan lisääntyvä tarve tuottaa jatkojalosteita on asettanut kuivauksen laatutasolle uusia haasteita ja laadukkaan kuivauksen tulos on perusta jatkojalosteiden toimivuudelle. Yhä enemmän tarvitaan kuivausprosessin ja kuivattavan puumateriaalin kontrollointia läpi koko kuivausprosessin. Näillä toimenpiteillä varmistetaan haluttu kuivauslaatu sisäisille ja ulkoisille asiakkaille yrityksessä. Tämän tutkimuksen tarkoituksena oli selvittää männyn sydänpuuhun muodostuvaa kosteuspitoisuutta kamarikuivausprosessissa. Keinokuivauksen tavoitteellinen loppukosteus oli 12 % kuivapainosta puumateriaalia. Jo aikaisempien tutkimusten perusteella on voitu osoittaa, että loppukosteuden arvo vaihtelee kuivauserässä eri _kappaleiden välillä johtuen puumateriaalin epähomogeenisuudesta. Sydänpuuvaltainen ja tiheä mäntysahatavara, joka sahataan tyvitukeista läheltä juuriosaa sisältää tämän tutkimuksen mukaan runsaasti pihkaa verrattuna latvaosassaan samaa sahetta. Kosteusgradientti on myös suurempi sahatavarakappaleiden tyviosassa. Vuosikasvun ja tiheyden korrelaatio on heikko männyn sydänpuulla. Kesäpuuprosentin korrelaatio tiheyteen on erittäin merkittävä. Pihkapitoisuus lisää puuaineen tiheyttä tyviosassa sahetta. Pintakovuus on puumateriaalin muodonmuutos potentiaali, kun kosteuspitoisuudet tasaantuvat poikkileikkauksessa. Kosteusgradientilla on selvä yhteyspintakovuuteen eli muodonmuutospotentiaaliin.

Metallialan pk-yrityksen arvon määrittäminen

Monen pk-yrityksen kohdalla sukupolvenvaihdos on ajankohtainen. Sukupolvenvaihdos voi tapahtua yrittäjän perheensisällä tai yrityskaupalla yksityiselle henkilölle, ryhmälle tai toiselle yritykselle. Kaikissa tapauksissa yrityksen arvo joudutaan määrittämään. Diplomityön tavoite oli kehittää matemaattinen kaava yrityksen arvon määrittämiseen ottaen huomioon yrityksen teknologinen tilanne, henkilöstöresurssitja asema markkinoilla. Tavoitteena oli myös pystyä luomaan menettely riittävien tietojen keräämisen mahdollisimman tehokkaasti ja pienin kustannuksin. Kaavan varmistamiseksi tarvittavien auditoitavien tietojen määrittely oli työn kirjallinen osa. Kolmen kohdeyrityksen auditoinnin avulla tehty selvitys tarkensi yrityksen arvon määritykseen tarvittavat tiedot. Työn lopussa arvioidaan yrityksen arvon määrityksen kehityskohteita ja tekijöitä, joihin panostamalla voi kohottaa yrityksen arvoa ja helpottaa yrityksen sukupolvenvaihdosta.