Non-small cell lung cancer : studies on pathogenesis, tumour targeting and treatment outcomes

Lung cancer accounts for more cancer-related deaths than any other cancer. In Finland, five-year survival ranges from 8% to 13%. The main risk factor for lung cancer is long-term cigarette smoking, but its carcinogenesis requires several other factors. The aim of the present study was to 1) evaluate post-operative quality of life, 2) compare clinical outcomes between minimally invasive and conventional open surgery, 3) evaluate the role of oxidative stress in the carcinogenesis of non-small lung cancer (NSCLC), and 4) to identify and characterise targeted agents for therapeutic and diagnostic use in surgery. For study I, pneumonectomy patients replied to 15D quality of life and baseline dyspnea questionnaires. Study III involved a prospective quality of life assessment using the 15D questionnaire after lobectomy or bi-lobectomy. Study IV was a retrospective comparison of clinical outcomes between 212 patients treated with open thoracotomy and 116 patients who underwent a minimally invasive technique. Study II measured parameters of oxidative metabolism (myeloperoxidase activity, glutathione content and NADPH oxidase activity) and DNA adducts. Study V employed the phage display method and identified a core motif for homing peptides. This method served in cell-binding, cell-localisation, and biodistribution studies. Following both pneumonectomy and lobectomy, NSCLC patients showed significantly decreased long-term quality of life. No significant correlation was noted between post-operative quality of life and pre-operative pulmonary function tests. Women suffered more from increased dyspnea after pneumonectomy which was absent after lobectomy or bi-lobectomy. Patients treated with video-assisted thoracoscopy showed significantly decreased morbidity and shorter periods of hospitalization than did open surgery patients. This improvement was achieved even though the VATS patients were older and suffered more comorbid conditions and poorer pulmonary function. No significant differences in survival were noted between these two groups. An increase in NADPH oxidase activity was noted in tumour samples of both adenocarcinoma and squamous cell carcinoma. This increase was independent from myeloperoxidase activity. Elevated glutathione content was noted in tumour tissue, especially in adenocarcinoma. After panning the clinical tumour samples with the phage display method, an amino acid sequence of ARRPKLD, the Thx, was chosen for further analysis. This method proved selective of tumour tissue in both in vitro and in vivo cell-binding assay, and biodistribution showed tumour accumulation. Because of the significantly reduced quality of life following pneumonectomy, other operative strategies should be implemented as an alternative (e.g. sleeve-lobectomy). To treat this disease, implementation of a minimally invasive surgical technique is safe, and the results showed decreased morbidity and a shorter period of hospitalisation than with thoracotomy. This technique may facilitate operative treatment of elderly patients with comorbid conditions who might otherwise be considered inoperable. Simultaneous exposure to oxidative stress and altered redox states indicates the important role of oxidative stress in the pathogenesis and malignant transformation of NSCLC. The studies showed with great specificity and with favourable biodistribution that Thx peptide is specific to NSCLC tumours. Thx thus shows promise in imaging, targeted therapy, and monitoring of treatment response.

Numeroiden harhaa vai toteutuksen työkaluja? -indikaattorien käyttö maatalouden ympäristöpoliittisessa suunnittelussa

This research focused on indicators with the aim of recognizing the main characters of this particular tool. The planning and use of Finnish sustainability indicators for natural resource management was examined as well as the experiences about the international sets of agri-environmental indicators were described. In both cases, the actual utilization of information was found to be quite minimal. Indicators have succeeded in bringing more of environmental information into the processes of decision making, but information has not been directly shifted into the actions of natural resource management. The concept of technical use of indicators was presented and considered as a possible explanation for the failures of information transfer and communication. Traditionally indicators have been used in order to recognize and describe the performance of certain system; to provide clear operative message for the actors. In policy planning, the situation is essentially different. We may lack both the jointly shared and accepted objectives of development as well the reliable and representative methods for measuring the issue under attention. Therefore, the technical orientation of using indicators may cause several problems at the policy forum. The study identified the risks of 1) reduced informative basis of decision-making, 2) narrowed approach of interpreting the data, 3) the focus on the issues that already are best documented and provides the most representative data series, and 4) the risks of losing the systemic viewpoints while focusing on measurable details of the system. Technical use of indicators may also result the excessive focus on information while being detached from the actions. With sustainability indicators, the major emphasis was indeed paid with producing information while the reality of agricultural practices was left mostly unaffected. Therefore, the essential process of social learning, where actions and producing of relevant information are alternating was neither realized. This study underlines the complexity of information transfer, mutual communication and the learning of new practices. Besides the information and measurable number people also need personal experiences and interesting stories, which make them to understand the meaning of information in their own lives. Particularly important this is for thechildren, who are studying for to be the future decision-makers of food system; in production as well as the in consumption of food. Numbers will be useful tools of management as soon there exists the awareness of the direction, where to strive for.

Mid-urethral slings for treatment of stress urinary incontinence : long- and mid-term follow-up

Urinary incontinence is a common problem, affecting one third of the women at least at some time during their lives. The prevalence of urinary incontinence increases with advancing age, and the everyday impact of incontinence on women and on health services is enormous. Urinary incontinence is usually divided into three different subtypes, of which stress urinary incontinence (SUI) is the most common. Surgical treatment is often needed to cure SUI, and modern mid-urethral sling procedures give the possibility to cure this condition with a low risk of adverse events, a problem often associated with the so-called traditional incontinence operations. Life expectancy among women in Western countries has grown beyond 80 years of age. Long-term efficacy of treatment options for urinary incontinence therefore becomes an important issue in a world with limited eco-nomic resources. The purpose of the present study was to prospectively evaluate the long-term efficacy and safety of the first minimally invasive mid-urethral tape procedure, the Tension-free Vaginal Tape (TVT) procedure. The long-term (5-year) follow-up results of the TVT procedure as a repeat operation af-ter an unsuccessful mid-urethral tape operation were studied and the reasons for failure of the first operation were analyzed. Another purpose was to compare the original TVT procedure with a newer modification, the Tension-free Vaginal Tape Obturator (TVT-O) procedure within a multi-centre, randomized context in order to find out possible differences between these procedures re-garding efficacy and complications and the effects on symptoms of urgency. The first study of the present thesis is a prospective, Nordic, three-centre follow-up study of 90 women suffering from SUI, who were treated by means of the TVT procedure. The mean follow-up time was more than eleven years, and the study is the first to be published in connection with more than ten years of follow-up. The second study is a retrospective analysis of 26 women who were treated with a repeat TVT procedure after an unsuccessful primary mid-urethral tape procedure. The third and fourth studies concern 273 women in seven centres in Finland who were ran-domly assigned to the TVT and TVT-O procedures, the 3-year follow-up results of which are pre-sented in this thesis. After eleven years of follow-up, 90% of the women had a negative cough stress test result and a negative 24-h pad test result. The subjective cure rate measured as the women s global impression of cure was 77%, the rate of improvement 20%, and only 3% thought that the treatment had failed. No late-onset adverse effects were found. The repeat TVT procedure was successful in 75% of the cases when women who were cured and women who were significantly improved were included. The reasons for failure of the first operation could be separated into four different groups: tape material-related, operation technique-related, concomitant illness-related and a group with no identifiable reason. There were no intra-operative complications during the repeat operation. In the randomized trial comparing the TVT with the TVT-O procedure a cough stress test results were negative in 94.6% and 89.5% of the women in the two groups, respectively, after a 3-year follow-up period. There were no statistical differences in the cure rate or the rate of complications be-tween the two procedures. Symptoms of urgency were analyzed more closely and the main finding was that the prevalence of urgency symptoms decreased significantly after both mid-urethral sling procedures. The TVT operation was found to be an effective and safe procedure even after eleven years of follow-up. Long-term follow-up after a repeat TVT procedure revealed that the TVT procedure can well be considered after an unsuccessful mid-urethra tape procedure, because 75% of the patients showed significantly improvement of their incontinence. The TVT and TVT-O procedures showed no statistically significant differences in efficacy and rate of complications after three years of follow-up. In most cases these procedures alleviate preoperative symptoms of urgency and the risk of developing de novo urgency is low.

Seasonal variation in the onset of egg laying in a primitively eusocial wasp: implications for the evolution of sociality

When freshly eclosed females of the primitively eusocial wasp, Rapalidia marginata are isolated into individual cages, only about half of them build nests and lay eggs and those that do so take a long and variable amount of time (Mean +/- SD = 66 +/- 37 days) before they lay their first egg. Part of the reason for this delay is because, when kept in isolation, no wasp begins to lay eggs during a period of approximately 82 days from mid - October to early January. Wasps maintained at a constant temperature of 26 +/- 1-degrees-C however initiate egg laying throughout the year, suggesting that the low temperatures during mid - October to early January may be at least one factor that makes this period unfavourable for wasps maintained at room temperature. Egg laying continues more or less normally throughout October-January however, in all natural and laboratory colonies studied. Natural colonies of R. marginata are initiated throughout the year and often by groups of females. Huddling together is a striking feature of the wasps especially on cold mornings. We therefore suggest that the isolated animals in our experiment are unable to lay eggs during the coldest part of the year because of their inability to huddle together, share metabolic heat and perform "co-operative thermoregulation". Such "co-operative thermoregulation" may thus be another factor that facilitates the evolution of socialitly.

High-risk patients and high-risk grafts in infrainguinal bypass for critical limb ischaemia

The main purpose of revascularization procedures for critical limb ischaemia (CLI) is to preserve the leg and sustain the patient s ambulatory status. Other goals are ischaemic pain relief and healing of ischaemic ulcers. Patients with CLI are usually old and have several comorbidities affecting the outcome. Revascularization for CLI is meaningless unless both life and limb are preserved. Therefore, the knowledge of both patient- and bypass-related risk factors is of paramount importance in clinical decision-making, patient selection and resource allocation. The aim of this study was to identify patient- and graft-related predictors of impaired outcome after infrainguinal bypass for CLI. The purpose was to assess the outcome of high-risk patients undergoing infrainguinal bypass and to evaluate the usefulness of specific risk scoring methods. The results of bypasses in the absence of optimal vein graft material were also evaluated, and the feasibility of the new method of scaffolding suboptimal vein grafts was assessed. The results of this study showed that renal insufficiency - not only renal failure but also moderate impairment in renal function - seems to be a significant risk factor for both limb loss and death after infrainguinal bypass in patients with CLI. Low estimated GFR (PIENEMPI KUIN 30 ml/min/1.73 m2) is a strong independent marker of poor prognosis. Furthermore, estimated GFR is a more accurate predictor of survival and leg salvage after infrainguinal bypass in CLI patients than serum creatinine level alone. We also found out that the life expectancy of octogenarians with CLI is short. In this patient group endovascular revascularization is associated with a better outcome than bypass in terms of survival, leg salvage and amputation-free survival especially in presence of coronary artery disease. This study was the first one to demonstrate that Finnvasc and modified Prevent III risk scoring methods both predict the long-term outcome of patients undergoing both surgical and endovascular infrainguinal revascularization for CLI. Both risk scoring methods are easy to use and might be helpful in clinical practice as an aid in preoperative patient selection and decision-making. Similarly than in previous studies, we found out that a single-segment great saphenous vein graft is superior to any other autologous vein graft in terms of mid-term patency and leg salvage. However, if optimal vein graft is lacking, arm vein conduits are superior to prosthetic grafts especially in infrapopliteal bypasses for CLI. We studied also the new method of scaffolding suboptimal quality vein grafts and found out that this method may enable the use of vein grafts of compromised quality otherwise unsuitable for bypass grafting. The remarkable finding was that patients with the combination of high operative risk due to severe comorbidities and risk graft have extremely poor survival, suggesting that only relatively fit patients should undergo complex bypasses with risk grafts. The results of this study can be used in clinical practice as an aid in preoperative patient selection and decision-making. In the future, the need of vascular surgery will increase significantly as the elderly and diabetic population increases, which emphasises the importance of focusing on those patients that will gain benefit from infrainguinal bypass. Therefore, the individual risk of the patient, ambulatory status, outcome expectations, the risk of bypass procedure as well as technical factors such as the suitability of outflow anatomy and the available vein material should all be assessed and taken into consideration when deciding on the best revascularization strategy.

Osallistuminen ja läpinäkyvyys kuntatasolla : tapaustutkimus Nicaraguasta

In this Master's thesis I go through the principals of the good governance. I apply these principals to the Nicaraguan context and especially in two rural municipalities in Chontales department. I clarify the development of the space of participation in Nicaraguan municipal level. I start my examination from the period when Somoza dictatorship ended and first open elections were held, and I end it to the municipal eleccions held in November 2008. These elections were robbed in 33 municipalities and because of this there started a crisis in Nicaragua and among the actors of development cooperation. As a methods of research I use two types of interview in the thesis, the interviews for the citizens and interviews for the experts. These interviews answer to my questions of the methods of participation. I also review the level of the trust of a citizen to an authority by asking if s/he voted in the municipal eleccions in November 2008. Furthermore, I define the work of municipal government in the point of view of the citizen. I also find out if a citizen wants to take more part in the decision making in her/his municipal. I have classified the types of citizens by the interviews I made. Due to this classification I explain how many people actually have opportunity to participate the dialogue of the municipal decision making and how many can follow the activity of the municipal governance. The result is that after the elections in November 2008 only one typed group can freely take part in the dialogue. This does not apply the principals of good governance, especially in subterms of participation and transparency. The incidents after the municipal elections have affected strongly on the co-operation of Finland and Nicaragua. Because of the fault of the elections Finland like the other co-operative countries brought down the directly paid budget support. This has caused a great economical crisis in Nicaragua which the covering will take a long time. The Master's thesis is a case study of two rural municipalities called Santo Tómas and Villa Sandino. Santo Tómas has a sandinista municipal government which is not legitimate. In Villa Sandino the government is liberal and legitimate.

Asemakaavoitus Helsingin seudun kasvun hallinnassa

Many Finnish municipalities need to control their growth. In this research growth is understood as developments of land utilisation and also as a wide range of other changes that have mainly ap-peared as a result of a long term growth in population. The development growth control contains four areas: 1. adequate productivity of town planning, 2. stationing the growth to needs led and for sustainable developments, 3. quality of the developing environment, and 4. producing growth with communicative and transparent process. The aim of the research is to represent connection between town planning and development growth control. Research defines the role of town planning in the municipalities development growth control. In addition research focuses on links between town planning and development growth control in history, present and in the development work for the future. According to the hypothesis the extensive examination of town planning enables better growth control and promotes appropriate response to municipal changes regarding housing delivery. As an example there are five outskirt municipalities in the Helsinki region. They are called Kirkkonummi, Vihti, Nurmijärvi, Tuusula and Sipoo. The decision was to use examples based on a contingence theory. According to the theory there is no one correct way to operate. Therefore development should be based on individual municipal needs. In the research, municipality s needs were collected by 20 semi- structured interviews from municipal officials. In addition there were group interviews in Uusimaa Regional Council and in Uusimaa Regional Environmental Centre. There was also secondary material collected from official papers and statistics. Operationalisation was the analysis tool between empiric and literature reviews. The role of town planning has evolved during the 20th century from a more simple town plan level to operative stage in town planning hierarchy. Outskirt municipalities town planning was established during the 1960s. Since then one of the most important aims in the town planning has been to produce growth and building possibilities. Currently the challenge is to reach the satisfying rate of productivity and to meet increased housing demand. Other challenges include locating the appropriate geographical areas for growth; and the balance between required developments and planning permission decisions. Findings concluded that town planning should be more viable and it should have better ability to co-operate and operate in the changing operational environment. Municipality s ability to receive growth can increase and growth control can advance by planned and workable town planning. It is essential to take wide perspective of the each municipality's unique needs to improve productivity rather than to focus simply on productivity.

High-temperature low-cycle fatigue behavior of a NIMONIC PE-16 superalloy—Correlation with deformation and fracture

Low-cycle fatigue (LCF) responses of NIMONIC PE-16 for various prior microstructures and strain amplitudes have been evaluated and the fatigue behavior has been explained in terms of the operative deformation mechanisms. Total strain-controlled LCF tests were performed at 923 K on samples possessing three different prior microstructures: alloy A in solution-annealed condition (free of γ′ and carbides), alloy B with double aging treatment (spherical γ′ of 18-nm diameter and M23C6), and alloy C with another double aging treatment (γ′ of size 35 nm, MC and M23C6). All three microstructures exhibited an intial cyclic hardening followed by a period of gradual softening at 923 K. Coffin-Manson plots describing the plastic strain amplitudevs number of reversals to failure showed that alloy A had maximum fatigue life while C showed the least. Alloy B exhibited a two-slope behavior in the Coffin-Manson plot over the strain amplitudes investigated. This has been ascribed to the change in the degree of homogeneity of deformation at high and low strain amplitudes. Transmission electron microscopic studies were carried out to characterize the various deformation mechanisms and precipitation reactions occurring during fatigue testign. Fresh precipitation of fine γ′ was confirmed by the development of “mottled contrast” in alloy C. Evidence for the shearing of the ordered γ′ precipitates was revealed by the presence of superdislocations in alloy C. Repeated shearing during cyclic loading led to the reduction in the size of the γ′ and consequent softening. Coarser γ′ precipitates were associated with Orowan loops. The observed fatigue behavior has been rationalized based on the micromechanisms stated above and on the degree of homogenization of slip assessed by slipband spacing measurements on tested samples.

Diffusion of sorbates in zeolites Y and A novel dependence on sorbate size and strength of sor ba t e-Zeoli t e interaction

A systematic investigation of monatomic spherical sorbates in the supercages of zeolites Y and A by molecular dynamics technique is presented. Rates of intercage diffusion, rates of cage visits, and the diffusion coefficients have been calculated as a function of the sorbate-zeolite interaction strength. These properties exhibit markedly different dependences on interaction strength for the two zeolites. The observed behavior is shown to be a consequence of the two principal mechanisms of intercage diffusion and the energetic barrier associated with them. The diffusion coefficient and other properties associated with intercage diffusion are found to be directly proportional to the reciprocal of the square of the sorbate diameter when the sorbate diameter is significantly smaller than the window diameter. As the sorbate diameter increases, a peak is observed in all the transport properties investigated including the diffusion coefficient. We call this surprising effect as the ring or levitation effect and it explains several anomalous results reported in the literature and suggests a breakdown of the geometrical criterion for diffusion of sorbates. It shows that under certain conditions nongeometrical factors play a major role and geometrical factors become secondary in the determination of the molecular sieve property. A generalized parameter has been proposed which suggests conditions under which one can expect the ring or levitation effect in any porous medium. Inverse size selectivity becomes operative under these conditions.

Study of Texture Evolution at High Strain Rates in FCC Materials

Evolution of crystallographic texture during high strain rate deformation in FCC materials with different stacking fault energy (Ni, Cu, and Cu-10Zn alloy) has been studied. The texture evolved in FCC materials at these strain rates show little dependence on the Stacking Fault Energy and the amount of deformation. Copper shows an anomalous behavior that is attributed to the ease of cross slip and continuous Dynamic Recrystallization that are operative under the experimental conditions.

Social selection and the evolution of cooperative groups: The example of the cellular slime moulds

In social selection the phenotype of an individual depends on its own genotype as well as on the phenotypes, and so genotypes, of other individuals. This makes it impossible to associate an invariant phenotype with a genotype: the social context is crucial. Descriptions of metazoan development, which often is viewed as the acme of cooperative social behaviour, ignore or downplay this fact. The implicit justification for doing so is based on a group-selectionist point of view. Namely, embryos are clones, therefore all cells have the same evolutionary interest, and the visible differences between cells result from a common strategy. The reasoning is flawed, because phenotypic heterogeneity within groups can result from contingent choices made by cells from a flexible repertoire as in multicellular development. What makes that possible is phenotypic plasticity, namely the ability of a genotype to exhibit different phenotypes. However, co-operative social behaviour with division of labour requires that different phenotypes interact appropriately, not that they belong to the same genotype, or have overlapping genetic interests. We sketch a possible route to the evolution of social groups that involves many steps: (a) individuals that happen to be in spatial proximity benefit simply by virtue of their number; (b) traits that are already present act as preadaptations and improve the efficiency of the group; and (c) new adaptations evolve under selection in the social context-that is, via interactions between individuals-and further strengthen group behaviour. The Dictyostelid or cellular slime mould amoebae (CSMs) become multicellular in an unusual way, by the aggregation of free-living cells. In nature the resulting group can be genetically homogeneous (clonal) or heterogeneous (polyclonal); in either case its development, which displays strong cooperation between cells (to the extent of so-called altruism) is not affected. This makes the CSMs exemplars for the study of social behaviour.

Solid-state photobehaviour and crystal packing of o-chlorobenzylidene-DL-piperitone: influence of molecular topology on photobehaviour

C17H19ClO, M(r) = 274.7, triclinic, P1BAR, a = 11.154 (3), b = 12.685 (2), c = 12.713 (2) angstrom, alpha = 100.68 (1), beta = 113.58 (1), gamma = 104.50 (2)-degrees, V = 1511.1 (6) angstrom3, Z = 4, D(m) = 1.22, D(x) = 1.215 Mg m-3, Cu K-alpha, lambda = 1.5418 angstrom, mu = 2.16 mm-1, F(000) = 584, T = 293 K, R = 0.057 for 3481 observed reflections. The title compound is photostable in the crystalline state and lattice-energy calculations have been employed to rationalize the photobehaviour. The well-known beta-steering ability of the chloro group is not operative in this system as there are no Cl...Cl interactions in the crystal lattice. All five benzylidene-DL-piperitone structures so far studied are alpha-packed and the molecular topology appears to be a deciding factor even in the presence of steering groups.

Finite element simulations of ductile rupture in a constrained metal foil

A numerical study of the ductile rupture in a metal foil constrained between two stiff ceramic blocks is performed. The finite element analysis is carried out under the conditions of mode I, plane strain, small-scale yielding. The rate-independent version of the Gurson model that accounts for the ductile failure mechanisms of microvoid nucleation, growth and coalescence is employed to represent the behavior of the metal foil. Different distributions of void nucleating sites in the metal foil are considered for triggering the initiation of discrete voids. The results clearly show that far-field triaxiality-induced cavitation is the dominant failure mode when the spacing of the void nucleating sites is large. On the contrary, void coalescence near the notch tip is found to be the operative failure mechanism when closely spaced void nucleating sites are considered.

Solid Oxide-Ion Electrolytes

Solid oxide-ion electrolytes find application in oxygen sensors, oxygen pumps and in high-temperature electrolyser-fuel-cell hybrid systems. All the solid electrolytes known so Qr, however, exhibit: tow oxide-ion conductivities below 973 K. Therefore, there is a need for fast oxide-ion conductors operative at temperatures around 673 K, Recently, efforts have been directed towards developing such materials. This article summarizes various type of oxide-ton electrolytes reported in literature and outlines a strategy for the identificatiom/synthesis of improved materials.

Investigation of valence states in the perovskite oxides, LaAFeNbO(6) (A = Ca, Sr)

Compounds of the type, LaAFeNbO(6) (A = Ca Sr) have been synthesized to study the electrical and magnetic properties and to examine valence degeneracy. The results show that valence degeneracy is not operative and the compounds are insulating. Magnetic susceptibility data show that part of the Fe is in Fs(2+) state, thus oxidizing part of Nb4+ to Nb5+ by an internal redox mechanism. The presence of mixed valent Fe is confirmed by Mossbauer spectra. (C) 1999 Elsevier Science B.V. All rights reserved.