Effects of Sucroferric Oxyhydroxide Compared to Lanthanum Carbonate and Sevelamer Carbonate on Phosphate Homeostasis and Vascular Calcifications in a Rat Model of Chronic Kidney Failure.

Elevated serum phosphorus, calcium, and fibroblast growth factor 23 (FGF23) levels are associated with cardiovascular disease in chronic renal disease. This study evaluated the effects of sucroferric oxyhydroxide (PA21), a new iron-based phosphate binder, versus lanthanum carbonate (La) and sevelamer carbonate (Se), on serum FGF23, phosphorus, calcium, and intact parathyroid hormone (iPTH) concentrations, and the development of vascular calcification in adenine-induced chronic renal failure (CRF) rats. After induction of CRF, renal function was significantly impaired in all groups: uremic rats developed severe hyperphosphatemia, and serum iPTH increased significantly. All uremic rats (except controls) then received phosphate binders for 4 weeks. Hyperphosphatemia and increased serum iPTH were controlled to a similar extent in all phosphate binder-treatment groups. Only sucroferric oxyhydroxide was associated with significantly decreased FGF23. Vascular calcifications of the thoracic aorta were decreased by all three phosphate binders. Calcifications were better prevented at the superior part of the thoracic and abdominal aorta in the PA21 treated rats. In adenine-induced CRF rats, sucroferric oxyhydroxide was as effective as La and Se in controlling hyperphosphatemia, secondary hyperparathyroidism, and vascular calcifications. The role of FGF23 in calcification remains to be confirmed.

Impact of the introduction of real-time therapeutic drug monitoring on empirical doses of carbapenems in critically ill burn patients.

PURPOSE: Adequate empirical antibiotic dose selection for critically ill burn patients is difficult due to extreme variability in drug pharmacokinetics. Therapeutic drug monitoring (TDM) may aid antibiotic prescription and implementation of initial empirical antimicrobial dosage recommendations. This study evaluated how gradual TDM introduction altered empirical dosages of meropenem and imipenem/cilastatin in our burn ICU. METHODS: Imipenem/cilastatin and meropenem use and daily empirical dosage at a five-bed burn ICU were analyzed retrospectively. Data for all burn admissions between 2001 and 2011 were extracted from the hospital's computerized information system. For each patient receiving a carbapenem, episodes of infection were reviewed and scored according to predefined criteria. Carbapenem trough serum levels were characterized. Prior to May 2007, TDM was available only by special request. Real-time carbapenem TDM was introduced in June 2007; it was initially available weekly and has been available 4 days a week since 2010. RESULTS: Of 365 patients, 229 (63%) received antibiotics (109 received carbapenems). Of 23 TDM determinations for imipenem/cilastatin, none exceeded the predefined upper limit and 11 (47.8%) were insufficient; the number of TDM requests was correlated with daily dose (r=0.7). Similar numbers of inappropriate meropenem trough levels (30.4%) were below and above the upper limit. Real-time TDM introduction increased the empirical dose of imipenem/cilastatin, but not meropenem. CONCLUSIONS: Real-time carbapenem TDM availability significantly altered the empirical daily dosage of imipenem/cilastatin at our burn ICU. Further studies are needed to evaluate the individual impact of TDM-based antibiotic adjustment on infection outcomes in these patients.

Mikroaaltopahveihin käytettävien lainereiden kerroksellisuuden merkitys

Diplomityön tavoitteena oli selvittää millaisia mikroaaltopahveihin käytettävien lainerikartonkien tulisi olla ja mitä ominaisuuksia niiltä vaaditaan. Työ on jaettu kirjallisuusosaan ja kokeelliseen osaan. Kirjallisuusosassa esitellään nykyisin käytetyt aaltopahvin raaka-aineet, aaltoprofiilit ja aaltopahvin valmistusprosessi sekä raaka-aineiden ja valmiin aaltopahvin testausmenetelmät ja tärkeät ominaisuudet. Kokeellinen osa koostuu laboratoriokokeista, pilot-koeajoista ja aaltopahvin valmistuksesta. Kokeellisen osan laboratoriovaiheessa käytetty massa fraktioitiin lyhyeen ja pitkään fraktioon. Lyhyestä ja pitkästä fraktioista valmistettiin eri fraktio-osuuksilla yksi- ja kaksikerrosarkkeja. Laboratorioarkkien neliömassa-alue oli 70 - 125 g/m2. Lisäksi muuttujana oli tiheys. Laboratoriomittausten perusteella parhaimmat rakenteet valittiin ajettavaksi pilot-mittakaavan koekartonkikoneella. Koekoneella valmistetuista yksi- ja kaksikerroskartongeista valmistettiin tehdasmittakaavassa F-aaltopahvia ja saadut rakenneyhdistelmät testattiin. Koetulosten perusteella voidaan sanoa, että mikroaaltolainerille on olemassa optimaalinen rakenne, joka riippuu painotettavasta ominaisuudesta. Pintaominaisuuksien painottaminen johtaa erilaiseen rakenteeseen kuin lujuusominaisuuksien painottaminen. Myös lainerin käyttökohde (pinta- tai taustalaineri) johtaa erilaiseen optimaaliseen rakenteeseen.

Heterosis in papaya: inter and intragroup analysis

Papaya (Carica papaya L.) is a typical crop of tropical areas, and Brazil is one of the leading world producers. In recent decades, papaya culture has expanded to different regions of the country, but the number of cultivars available is still limited. In the present study, a complete diallel cross was carried out using eight accessions of papaya from the UENF/Caliman germplasm bank. Four genotypes belong to the Formosa heterotic group and four, to the Solo group. This study aimed to evaluate the occurrence and viability of exploring heterosis in heterotic intragroup hybrids. Fifty-six hybrid progenies were generated and evaluated. Among the Formosa intragroup hybrids, two hybrid combinations (MR x J4 and MR x SK) showed heterosis for all traits, as well as good average total fruit production. Among the Solo intragroup hybrids, three hybrid combinations (WM x GG, WM x SS and WM x SM) stand out for fruit production and high content of soluble solids. In Formosa x Solo hybrids, all hybrid combinations with the parent JS (JS x WM, JS x GG, JS x SS and JS x SM) showed high fruit quality and good average for fruit production. The heterotic profile of the hybrids tested allowed the identification of promising hybrids within Formosa and Solo heterotic groups. The analysis of the canonical variables also allowed the visualization of distinct groups of hybrids, depending on the provenance of the parents.

Sakkaroosin hydrolyysi immobilisoidulla entsyymillä

Työssä tutkittiin sakkaroosin hydrolyysiä anioninvaihtohartseihin immobilisoidun entsyymin avulla tavoitteena löytää sellainen kantaja-entsyymi -yhdistelmä, jolla konversio halutuiksi lopputuotteiksi olisi mahdollisimman korkea. Työhön valittiin aikaisemmissa laboratoriokokeissa parhaita tuloksia saavuttaneet kantaja-entsyymi -parit. Entsyymeinä oli kaksi nestemäistä Saccharomyces cerevisiae -hiivasta eristettyjä entsyymivalmistetta. Kokeissa käytetyt kantajamateriaalit olivat erilaisia heikkoja anioninvaihtohartseja. Entsyymit immobilisoitiin kantajaan sekoitusreaktorissa ja niiden aktiivisuudet määritettiin sitomisen jälkeen. Hydrolyysikokeet tehtiin jatkuvatoimisessa kiintopetireaktorissa ja lisäksi panos-kokeina tutkittiin ominaisuuksiltaan erilaisten kantajien eroja hydrolyysissä. Reaktio-olosuhteet pidettiin kaikissa kokeissa samoina. Sakkaroosiliuoksen pitoisuus oli 50 p-%, reaktiolämpötila 50 oC ja pH 5. Kiintopetikolonnissa tutkittiin myös sakkaroosi-liuoksen viipymäajan vaikutusta sivutuotteiden syntyyn. Näytteet analysoitiin neste-kromatografilla. Kiintopetikolonnissa lyhimmän viipymäajan (15 min) kokeissa ainoastaan hitaimmilla kantaja-entsyymi -pareilla muodostui sivutuotteita, jotka hydrolyysireaktion edetessä kuitenkin hävisivät. Kun viipymäaikaa kasvatettiin sivutuotteiden synty väheni ja lopulta niitä ei havaittu syntyvän lainkaan. Hydrolyysin edetessä viipymäajan ollessa tarpeeksi pitkä pienet sivutuotekomponentit hävisivät sakkaroosin hajotessa kokonaan glukoosiksi ja fruktoosiksi. Verrattaessa partikkelikoon ja hartsimatriisin vaikutusta samaan entsyymiin sidottuna havaittiin, että niillä kummallakin on vaikutusta sekä sakkaroosin hydrolyysi-nopeuteen että sivutuotteiden muodostumiseen.

Yrityksen sisäisen kilpailun ja yhteistyön innovaatiovaikutus ja johtaminen t&k-toiminnassa

Tiedon luomiseen ja hyödyntämiseen perustuvassa liiketoiminnassa yrityksen kyky luoda tietoa ja käyttää hallussaan olevaa tietoa muodostaa perustan kilpailukyvylle ja kilpailueduille. Tutkielmassa rakennetaan konstruktiivista tutkimusotetta käyttäen innovaatioiden synnyn johtamiseen soveltuva toimintamalli Teecen tietoprosesseihin, Nonakan tiedonkonversioprosesseihin ja Ståhlen tietoympäristöihin perustuen. Tietoa syntyy esimerkiksi innovaatioissa. Innovaatioiden voidaan katsoa syntyvän vastakkaisten voimien jatkuvassa vuorovaikutuksessa. Tämä innovaatioita tuottava mekanismi rakentuu tietoa lisäävistä ja tietoa järjestävistä prosesseista, joita voidaan kuvata sekä seci-prosessin että kolmitasoisen tietoympäristön avulla. Sisäinen kilpailu ja yhteistyö vaikuttavat tämän mekanismin toimintaan. Yhteistyö lisää tiedon jakamista ja mahdollistaa radikaalien innovaatioiden ja tuoteinnovaatioiden synnyn. Kilpailun lisääminen vähentää keskinäistä tiedon jakamista ja siirtää innovaatioita fokuksen mukaisiin prosessi-innovaatioihin. Kilpailun ja yhteistyön määrään ja keskinäiseen suhteeseen voidaan vaikuttaa kolmitasoisesta tietoympäristömallista johdettujen kolmen erillisen, joskin toisiinsa vaikuttavan, johtamistavoitteen avulla. Mahdollistava johtaminen rakentaa luottamuksen ja yrityksen toiminnan perustaa. Valtuuttava johtaminen houkuttaa yhteistyöhön mahdollistaen tiedon lisääntymisen. Ohjaavan johtamisen prosessit vievät yritystä strategian mukaiseen suuntaan hyödyntäen sisäistä kilpailua.

Konsernitilinpäätöksen yhdistelyt IFRS-standardien mukaan

Tutkimuksen tavoitteena on IFRS-standardien eli uusien kansainvälisten raportointistandardien tuomien muutosten selvittäminen koskien konsernitilinpäätöksen yhdistelyjä. Tutkimusmenetelmä on normatiivinen, teoreettinen ja kvalitatiivinen. IAS/IFRS (International Accounting Standards / International Financial Reporting Standards eli kansainväliset raportointistandardit) tulee pakolliseksi pörssiyrityksille 1.1.2005 alkaen Euroopan Unionin alueella. IAS/IFRS:n mukaan tytäryritykset yhdistellään hankintamenomenetelmällä, osakkuusyritykset pääomaosuusmenetelmällä ja yhteisyritykset suhteellisella yhdistelyllä. Yritysten yhteenliittymät – standardi on olennaisesti uudistettu 31.3.2004. Pooling-menetelmä kiellettiin kokonaan. Hankintamenomenetelmässä kaikki yksilöitävissä olevat varat ja velat arvostetaan käypiin arvoihin. Aineettomien hyödykkeiden ryhmittelyssä on tapahtunut muutoksia. Yksilöitävissä olevat aineettomat hyödykkeet, esimerkiksi asiakassuhteet, aktivoidaan taseeseen ja poistetaan. Aineettomat hyödykkeet, joille ei ole määriteltävissä rajallista käyttöikää, tulee testata pakollisilla arvonalentumistestauksella. Siihen ryhmään kuuluu esimerkiksi liikearvo.

Snakefly diversity in Early Cretaceous amber from Spain (Neuropterida, Raphidioptera)

The Albian amber from Spain presently harbors the greatest number and diversity of amber adult fossil snakeflies (Raphidioptera). Within Baissopteridae, Baissoptera? cretaceoelectrasp. n., from the Peñacerrada I outcrop (Moraza, Burgos), is the first amber inclusion belonging to the family and described from western Eurasia, thus substantially expanding the paleogeographical range of the family formerly known from the Cretaceous of Brazil and eastern Asia. Within the family Mesoraphidiidae, Necroraphidia arcuatagen. et sp. n. and Amarantoraphidia ventolinagen. et sp. n. are described from the El Soplao outcrop (Rábago, Cantabria), whereas Styporaphidia? hispanicasp. n. and Alavaraphidia imperterritagen. et sp. n. are describedfrom Peñacerrada I. In addition, three morphospecies are recognized from fragmentary remains. The following combinations are restored: Yanoraphidia gaoi Ren, 1995, stat. rest., Mesoraphidia durlstonensis Jepson, Coram and Jarzembowski, 2009, stat. rest., and Mesoraphidia heteroneura Ren, 1997, stat. rest. The singularity of this rich paleodiversity could be due to the paleogeographic isolation of the Iberian territory and also the prevalence of wildfires during the Cretaceous.

Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: A systematic review and critical appraisal of the literature.

BACKGROUND: During the last decade, the management of blunt hepatic injury has considerably changed. Three options are available as follows: nonoperative management (NOM), transarterial embolization (TAE), and surgery. We aimed to evaluate in a systematic review the current practice and outcomes in the management of Grade III to V blunt hepatic injury. METHOD: The MEDLINE database was searched using PubMed to identify English-language citations published after 2000 using the key words blunt, hepatic injury, severe, and grade III to V in different combinations. Liver injury was graded according to the American Association for the Surgery of Trauma classification on computed tomography (CT). Primary outcome analyzed was success rate in intention to treat. Critical appraisal of the literature was performed using the validated National Institute for Health and Care Excellence "Quality Assessment for Case Series" system. RESULTS: Twelve articles were selected for critical appraisal (n = 4,946 patients). The median quality score of articles was 4 of 8 (range, 2-6). Overall, the median Injury Severity Score (ISS) at admission was 26 (range, 0.6-75). A median of 66% (range, 0-100%) of patients was managed with NOM, with a success rate of 94% (range, 86-100%). TAE was used in only 3% of cases (range, 0-72%) owing to contrast extravasation on CT with a success rate of 93% (range, 81-100%); however, 9% to 30% of patients required a laparotomy. Thirty-one percent (range, 17-100%) of patients were managed with surgery owing to hemodynamic instability in most cases, with 12% to 28% requiring secondary TAE to control recurrent hepatic bleeding. Mortality was 5% (range, 0-8%) after NOM and 51% (range, 30-68%) after surgery. CONCLUSION: NOM of Grade III to V blunt hepatic injury is the first treatment option to manage hemodynamically stable patients. TAE and surgery are considered in a highly selective group of patients with contrast extravasation on CT or shock at admission, respectively. Additional standardization of the reports is necessary to allow accurate comparisons of the various management strategies. LEVEL OF EVIDENCE: Systematic review, level IV.

Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable. Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings. Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar. Study selection: Our search terms included combinations of"secondhand smoke,""environmental tobacco smoke,""passive smoking" OR"tobacco smoke pollution" AND"outdoors" AND"PM" (particulate matter),"PM2.5" (PM with diameter ≤ 2.5 µm),"respirable suspended particles,""particulate matter,""nicotine,""CO" (carbon monoxide),"cotinine,""marker,""biomarker" OR"airborne marker." In total, 18 articles and reports met the inclusion criteria. Results: Almost all studies used PM2.5 concentration as an SHS marker. Mean PM2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m3 at hospitality venues, and 4.60 to 17.80 µg/m3 at other locations. Mean PM2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m3. SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers. Conclusions: The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.

Bevacizumab, Pemetrexed, and Cisplatin, or Bevacizumab and Erlotinib for Patients With Advanced Non-Small-Cell Lung Cancer Stratified by Epidermal Growth Factor Receptor Mutation: Phase II Trial SAKK19/09.

OBJECTIVE: The goal was to demonstrate that tailored therapy, according to tumor histology and epidermal growth factor receptor (EGFR) mutation status, and the introduction of novel drug combinations in the treatment of advanced non-small-cell lung cancer are promising for further investigation. METHODS: We conducted a multicenter phase II trial with mandatory EGFR testing and 2 strata. Patients with EGFR wild type received 4 cycles of bevacizumab, pemetrexed, and cisplatin, followed by maintenance with bevacizumab and pemetrexed until progression. Patients with EGFR mutations received bevacizumab and erlotinib until progression. Patients had computed tomography scans every 6 weeks and repeat biopsy at progression. The primary end point was progression-free survival (PFS) ≥ 35% at 6 months in stratum EGFR wild type; 77 patients were required to reach a power of 90% with an alpha of 5%. Secondary end points were median PFS, overall survival, best overall response rate (ORR), and tolerability. Further biomarkers and biopsy at progression were also evaluated. RESULTS: A total of 77 evaluable patients with EGFR wild type received an average of 9 cycles (range, 1-25). PFS at 6 months was 45.5%, median PFS was 6.9 months, overall survival was 12.1 months, and ORR was 62%. Kirsten rat sarcoma oncogene mutations and circulating vascular endothelial growth factor negatively correlated with survival, but thymidylate synthase expression did not. A total of 20 patients with EGFR mutations received an average of 16 cycles. PFS at 6 months was 70%, median PFS was 14 months, and ORR was 70%. Biopsy at progression was safe and successful in 71% of the cases. CONCLUSIONS: Both combination therapies were promising for further studies. Biopsy at progression was feasible and will be part of future SAKK studies to investigate molecular mechanisms of resistance.

Types of stereoselectivity in drug metabolism: a heuristic approach.

Stereochemical factors are known to play a significant role in the metabolism of drugs and other xenobiotics. Following Prelog's lead, types of metabolic stereoselectivity can be categorized as (i) substrate stereoselectivity (the differential metabolism of two or more stereoisomeric substrates) and (ii) product stereoselectivity (the differential formation of two or more stereoisomeric metabolites from a single substrate). Combinations of the two categories exist as (iii) substrate-product stereoselectivities, meaning that product stereoselectivity itself is substrate stereoselective. Here, published examples of metabolic stereoselectivities are examined in the light of these concepts. In parallel, a graphical scheme is presented with a view to facilitate learning and help researchers to solve classification problems.

Abacavir/Lamivudine Versus Tenofovir/Emtricitabine in Virologically Suppressed Patients Switching from Ritonavir-Boosted Protease Inhibitors to Raltegravir

There are few clinical data on the combination abacavir/lamivudine plus raltegravir. We compared the outcomes of patients from the SPIRAL trial receiving either abacavir/lamivudine or tenofovir/emtricitabine at baseline who had taken at least one dose of either raltegravir or ritonavir-boosted protease inhibitors. For the purpose of this analysis, treatment failure was defined as virological failure (confirmed HIV-1 RNA ≥50 copies/ml) or discontinuation of abacavir/lamivudine or tenofovir/emtricitabine because of adverse events, consent withdrawal, or lost to follow-up. There were 143 (72.59%) patients with tenofovir/emtricitabine and 54 (27.41%) with abacavir/lamivudine. In the raltegravir group, there were three (11.11%) treatment failures with abacavir/lamivudine and eight (10.96%) with tenofovir/emtricitabine (estimated difference 0.15%; 95% CI -17.90 to 11.6). In the ritonavir-boosted protease inhibitor group, there were four (14.81%) treatment failures with abacavir/lamivudine and 12 (17.14%) with tenofovir/emtricitabine (estimated difference -2.33%; 95% CI -16.10 to 16.70). Triglycerides decreased and HDL cholesterol increased through the study more pronouncedly with abacavir/lamivudine than with tenofovir/emtricitabine and differences in the total-to-HDL cholesterol ratio between both combinations of nucleoside reverse transcriptase inhibitors (NRTIs) tended to be higher in the raltegravir group, although differences at 48 weeks were not significant. While no patient discontinued abacavir/lamivudine due to adverse events, four (2.80%) patients (all in the ritonavir-boosted protease inhibitor group) discontinued tenofovir/emtricitabine because of adverse events (p=0.2744). The results of this analysis do not suggest that outcomes of abacavir/lamivudine are worse than those of tenofovir/emtricitabine when combined with raltegravir in virologically suppressed HIV-infected adults.

Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

BACKGROUND: Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. METHODS: We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. RESULTS: Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8), 80.8% specificity (72.6-87.1), positive likelihood ratio 4.9 (3.4-7.1), negative likelihood ratio 0.083 (0.022-0.32), and misclassification rate 0.20 (standard error 0.038). CONCLUSIONS: In Tanzanian children with WHO-defined clinical pneumonia, combinations of host biomarkers distinguished between end-point pneumonia, other infiltrates, and normal chest x-ray, whereas clinical variables did not. These findings generate pathophysiological hypotheses and may have potential research and clinical utility.

Obese, smoker, and obese smoker : is there a general lifestyle gradient?

Aim: Obesity and smoking are major CVD risk factors and may be associated with other unfavourable lifestyle behaviours. Our aim was to investigate the significance of obesity, heavy smoking, and both combined in terms of prevalence trends and their relationship with other lifestyle factors. Methods: We used data from the population-based cross-sectional Swiss Health Survey (5 waves, 1992-2012) comprising 85,575 individuals aged 18 years. Height, weight, and smoking status were self-reported. We used multinomial logistic regression to analyse differences in lifestyle for the combinations of BMI category and smoking status, focusing on obese and heavy smokers. We defined normal-weight never smokers as reference.