Corpo estranho no ceco retirado por colonoscopia

The foreign body ingestion ocurrs often with children, olds, psychiatrics patients, prisoners or after excessive alcoholic ingestion. Most of foreign bodies (80-90%) passes spontaneously, 10 a 20% have to be removed by endoscopy and only one per cent (1%) needs to be removed by surgery. The authors report a case of a 49-year-old woman who swallowed a needle which impacted in cecum. The patient had psychosis maniac-depressive and swallowed the foreign body aiming self-damage. The presence of foreign body in cecum is rare because of physiologic straitments in the gastrointestinal tract. The ingestion of needle corresponds six percent (6%) of swallowed objects aiming self-damage. Colonoscopy served for localization the foreign body and its withdrawal with success. Colonoscopy for removing foreign bodies is a safe and cheap procedure.

Leiomiomas do esôfago removidos por vídeo-toracoscopia

This report describes three cases of esophageal leiomyomas successfully resected by thoracoscopy. Surgical enucleation through minimally invasive surgery is the treatment of choice for esophageal leiomyoma. The conventional approach through a formal thoracotomy has the potential of causing excessive pain and patient discomfort. Moreover, the hospital stay and the recovery period are prolonged. Indications for surgery were based mainly on the size of the mass (<4 cm) and the presence of dysphagia. In one case there was a clear suspicion of malignancy. The tumour was located in the lower thoracic esophagus (case 1), in the middle thoracic esophagus (case 2) and in the upper esophagus (case 3). The CT was useful in identifying the relationship between the lesion and the organs of the mediastinum. The barium swallow study was able to locate the lesion along the esophagus. The endosonography determined the boundaries of the lesions. A right thoracoscopic approach was undertaken. Dissection of the esophagus around its entire perimeter was never necessary because all tumours were anterior or right sided. The tumours were better grasped with a traction suture than with forceps. The hidrodissection was very helpful. The water-soluble contrast swallow, performed on the fourth postoperative day, was normal. Clinical results were satisfactory in all patients. Biopsies should never be performed when the mucosa overlying is normal.

CORPORATE SOCIAL RESPONSIBILITY from theory into financial statement: UPM-Kymmene Oyj

For number of reasons social responsibility in corporations has become a more essential part of business operations than before. Corporate social responsibility (CSR) is dealt with different means and aspects but the overall effects it has on organisations performance, communication and underline actions is indisputable. The thesis describes corporate social responsibility and the main objective was to observe how corporate social responsibility has developed in our case company with answering to main research question how CSR reporting has evolved in UPM-Kymmene Oyj? In addition following questions were also addressed: Is there a monetary value of CSR? What does proficient CSR report consist of? What does corporate social responsibility consist of? Qualitative research method, content analysis to be precise, was chosen and excessive literature study performed to find the theoretical back ground to perform the empirical part of the study. Data for the empirical part was collected from UPM-Kymmene Oyj financial data and annual reports. The study shows that UPM-Kymmene Oyj engagement to CSR and reporting of CSR matter have improved due time but still few managerial implications could be found. UPM-Kymmene Oyj economic key figures are only building shareholder value and stakeholders are identified in very general level. Also CSR data is scattered all over the annual report which causes problems to readers. The scientific importance of this thesis arises from the profound way CSR has been addressed in a holistic manner. Thus it is giving a good basis to understand the underlying reasons of CSR from society towards the organisation and vice versa.

Derivação biliopancreática com preservação gástrica videolaparoscópica: sistematização técnica

BACKGROUND: The authors describe a videolaparoscopic technical variation of biliopancreatic diversion, and its rationale, as well as its preliminary results.They operated on 12 female patients, age between 26 and 49 years, BMI range 47,4 and 59,5kg/m². There were no intraoperative complications; operative time ranged from 2 to 4,5 hours; discharge in the 3rd. postoperative day. Liquid dietetic recommendations in the early period, and normal diet after the first week. One patient was readmmitted after 1 week with abdominal pain because of excessive ingestion of food; there was deep venous trombosis in one patient. Follow-up showed loss of excess weight of 27,4% after four months. Initial results of the described operation sugests it may be a good alternative to morbid obesity surgical treatment; it is strongly required a multidisciplinar pre and postoperative treatment program.

Usable Privacy Preservation in Mobile Electronic Personality

Personalised ubiquitous services have rapidly proliferated due technological advancements in sensing, ubiquitous and mobile computing. Evolving societal trends, business and the economic potential of Personal Information (PI) have overlapped the service niches. At the same time, the societal thirst for more personalised services has increased and are met by soliciting deeper and more privacy invasive PI from customers. Consequentially, reinforcing traditional privacy challenges and unearthed new risks that render classical safeguards ine ective. The absence of solutions to criticise personalised ubiquitous services from privacy perspectives, aggravates the situation. This thesis presents a solution permitting users' PI, stored in their mobile terminals to be disclosed to services in privacy preserving manner for personalisation needs. The approach termed, Mobile Electronic Personality Version 2 (ME2.0), is compared to alternative mechanisms. Within ME2.0, PI handling vulnerabilities of ubiquitous services are identi ed and sensitised on their practices and privacy implications. Vulnerability where PI may leak through covert solicits, excessive acquisitions and legitimate data re-purposing to erode users privacy are also considered. In this thesis, the design, components, internal structures, architectures, scenarios and evaluations of ME2.0 are detailed. The design addresses implications and challenges leveraged by mobile terminals. ME2.0 components and internal structures discusses the functions related to how PI pieces are stored and handled by terminals and services. The architecture focusses on di erent components and their exchanges with services. Scenarios where ME2.0 is used are presented from di erent environment views, before evaluating for performance, privacy and usability.

Subjectivity in the valuation : Case study on the Finnish biotechnology industry

The thesis combines valuation and behavioral economics literature, which is not common among the Finnish management accounting research. Furthermore, the valuation is studied in biotechnology context and those type of studies are rather rare as well. The thesis studies the valuation in the Finnish biotechnology industry. The concepts of behavioral finance are employed in the empirical part of the study to explore decision-makers’ behavior in valuation processes. The main interest of this study is to explore how subjectivity of a decision-maker affects the valuation in the biotechnology industry. The valuation is studied from two perspectives. First, what is the best valuation model for biotechnology companies suggested by the valuation literature? Second, how the valuation in biotechnology industry is done in practice and how the decision-makers subjectivity affects the valuation? The literature review aims at seeking the best valuation model. The real options were found to be the most suitable valuation model for biotechnology companies, especially in the early stages of product development. The real option’s ability to take the value of the inherent options into account results in theoretically most correct valuations. The only disadvantage is the model’s complexity when compared to other models, such as discounted cash flow models. The empirical part of the study consists of a case study, which examines the valuation practices of the Finnish biotechnology companies. When it comes to the valuation models used in practice, it was found that the companies were using rather simple valuation models, which was due to two reasons. First, the interviewees did not believe in the valuation models and second, they were familiar neither with the most sophisticated models nor with all the theoretical aspects of the models they were using. The material for the study was collected with theme interviews. Four CEO’s of highly successful Finnish biotechnology companies. Strong signs of the decision-makers’ subjectivity in valuation were observed. Most obvious were the signs of framing. Furthermore, herding, excessive optimism, and overconfidence were present. All the behavioral concepts observed most likely have a severe effect on the valuation. As a result, the valuation can easily become overly optimistic, which leads to overvalued investments and to continuation of already unprofitable projects. Framing had the strongest evidence. If the product being valued is framed successfully, the risk of overvaluation is high, thus a strong belief can justify almost any value.

Incidence of deep vein thrombosis and quality of venous thromboembolism prophylaxis

OBJECTIVE: to determine the incidence of deep vein thrombosis and prophylaxis quality in hospitalized patients undergoing vascular and orthopedic surgical procedures. METHODS: we evaluated 296 patients, whose incidence of deep venous thrombosis was studied by vascular ultrasonography. Risk factors for venous thrombosis were stratified according the Caprini model. To assess the quality of prophylaxis we compared the adopted measures with the prophylaxis guidelines of the American College of Chest Physicians. RESULTS: the overall incidence of deep venous thrombosis was 7.5%. As for the risk groups, 10.8% were considered low risk, 14.9%moderate risk, 24.3% high risk and 50.5% very high risk. Prophylaxis of deep venous thrombosis was correct in 57.7%. In groups of high and very high risk, adequate prophylaxis rates were 72.2% and 71.6%, respectively. Excessive use of chemoprophylaxis was seen in 68.7% and 61.4% in the low and moderate-risk groups, respectively. CONCLUSION: although most patients are deemed to be at high and very high risk for deep vein thrombosis, deficiency in the application of prophylaxis persists in medical practice.

Leukocyte trafficking: a special focus on VAP-1 and CLEVER-1

It is crucial that lymphocytes patrol the body against foreign intruders and that leukocytes invade inflamed tissues to ameliorate the infection or injury. The adhesion molecules in leukocytes and endothelial cells play an essential role in the immune response by directing the traffic of leukocytes. However, the same molecules that guide leukocyte traffic under physiological conditions are also involved in pathological situations, when an overly excessive or harmful inflammatory response leads to tissue destruction and organ dysfunction or tumor growth. Vascular adhesion protein-1 (VAP-1) and Common lymphatic endothelial and vascular endothelial receptor-1 (CLEVER-1) are endothelial molecules that participate in the adhesion of leukocytes to the endothelia. This study was designed to elucidate, using different inflammation models, the role of VAP-1 and CLEVER-1 in leukocyte migration to the inflamed tissue, and to evaluate the use of antibodies against these molecules as an anti-adhesive therapy. Also, the role of CLEVER-1 during tumorigenesis was studied. Blocking the function of VAP-1 with antibodies significantly decreased the accumulation of leukocytes in the inflamed tissue. Targeting CLEVER-1 prevented cell migration via lymphatic vessels, as well as leukocyte traffic during inflammation. Following the anti-CLEVER-1 antibody treatment the number of immune regulating leukocytes in tumors was reduced, which led to a decrease in tumor growth. However, the normal immune response towards immunization or bacterial infection was not compromised. Thus, VAP-1 and CLEVER-1 are both potential targets for antiinflammatory therapies for preventing the harmful accumulation of leukocytes in inflamed areas. Targeting CLEVER-1 may also inhibit tumor growth by reducing immunosuppressive leukocytes in tumors

Exploration and Design of Power-Efficient Networked Many-Core Systems

Multiprocessing is a promising solution to meet the requirements of near future applications. To get full benefit from parallel processing, a manycore system needs efficient, on-chip communication architecture. Networkon- Chip (NoC) is a general purpose communication concept that offers highthroughput, reduced power consumption, and keeps complexity in check by a regular composition of basic building blocks. This thesis presents power efficient communication approaches for networked many-core systems. We address a range of issues being important for designing power-efficient manycore systems at two different levels: the network-level and the router-level. From the network-level point of view, exploiting state-of-the-art concepts such as Globally Asynchronous Locally Synchronous (GALS), Voltage/ Frequency Island (VFI), and 3D Networks-on-Chip approaches may be a solution to the excessive power consumption demanded by today’s and future many-core systems. To this end, a low-cost 3D NoC architecture, based on high-speed GALS-based vertical channels, is proposed to mitigate high peak temperatures, power densities, and area footprints of vertical interconnects in 3D ICs. To further exploit the beneficial feature of a negligible inter-layer distance of 3D ICs, we propose a novel hybridization scheme for inter-layer communication. In addition, an efficient adaptive routing algorithm is presented which enables congestion-aware and reliable communication for the hybridized NoC architecture. An integrated monitoring and management platform on top of this architecture is also developed in order to implement more scalable power optimization techniques. From the router-level perspective, four design styles for implementing power-efficient reconfigurable interfaces in VFI-based NoC systems are proposed. To enhance the utilization of virtual channel buffers and to manage their power consumption, a partial virtual channel sharing method for NoC routers is devised and implemented. Extensive experiments with synthetic and real benchmarks show significant power savings and mitigated hotspots with similar performance compared to latest NoC architectures. The thesis concludes that careful codesigned elements from different network levels enable considerable power savings for many-core systems.

Applications and Benefits of Adaptive Pulsed GMAW

In ship and offshore terminal construction, welded cross sections are thick and the number of welds very high. Consequently, there are two aspects of great importance; cost and heat input. Reduction in the welding operation time decreases the costs of the work force and avoids excessive heat, preventing distortion and other weld defects. The need to increase productivity while using a single wire in the GMAW process has led to the use of a high current and voltage to improve the melting rate. Unfortunately, this also increases the heat input. Innovative GMAW processes, mostly implemented for sheet plate sections, have shown significant reduction in heat input (Q), low distortion and increase in welding speed. The aim of this study is to investigate adaptive pulsed GMAW processes and assess relevant applications in the high power range, considering possible benefits when welding thicker sections and high yield strength steel. The study experimentally tests the usability of adaptive welding processes and evaluates their effects on weld properties, penetration and shapes of the weld bead.The study first briefly reviews adaptive GMAW to evaluate different approaches and their applications and to identify benefits in adaptive pulsed. Experiments are then performed using Synergic Pulsed GMAW, WiseFusionTM and Synergic GMAW processes to weld a T-joint in a horizontal position (PB). The air gap between the parts ranges from 0 to 2.5 mm. The base materials are structural steel grade S355MC and filler material G3Si1. The experiment investigates heat input, mechanical properties and microstructure of the welded joint. Analysis of the literature reveals that different approaches have been suggested using advanced digital power sources with accurate waveform, current, voltage, and feedback control. In addition, studies have clearly indicated the efficiency of lower energy welding processes. Interest in the high power range is growing and a number of different approaches have been suggested. The welding experiments in this study reveal a significant reduction of heat input and a weld microstructure with the presence of acicular ferrite (AF) beneficial for resistance to crack propagation. The WiseFusion bead had higher dilution, due to the weld bead shape, and low defects. Adaptive pulse GMAW processes can be a favoured choice when welding structures with many welded joints. The total heat reduction mitigates residual stresses and the bead shape allows a higher amperage limit. The stability of the arc during the process is virtually spatter free and allows an increase in welding speed.

Does hyperglycemia in pregnancy change fetal kidney growth?: a longitudinal prospective study

PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.

Character transformations and their functional significance as a key to the evolution of hystricognath Rodentia

Hystricognathi represent a monophyletic taxon within Rodentia. Since phylogenetically analyzed morphological systems are essential for revealing evolutionary processes, this study identifies evolutionary character transformations on the stem lineage of Hystricognathi as derived from the author's own work and the literature. Data so far indicate that evolutionary transformations in the rostral head region, the loss of tactile ability in the outer nasal skin and the mobile arrangement of the associated cartilage, were allied with a switch from omnivorous to herbivorous and fiber-rich nutrition. Additional character transformations in the skull assist in digesting such food. Structures associated with reproduction and placentation show a remarkable pro portion of derived character conditions: the chorioallantoic placenta has a ring-shaped organization and growth structure which optimizes the capacity for passive diffusion, a subplacenta occurred as a specialized region responsible for placental invasion and the inverted yolk sac facilitates substance exchange with the main placenta. Finally, precocial newborns evolved as a derived condition within Rodentia. All things considered, a mode of reproduction is indicated, which does not demand excessive additional energy intake by the mother and is in accordance with her low energetic diet. Hystricognathi possess major character transformations that represent prerequisites for their successful radiation at the time when more open ecosystems and grasslands evolved during Earth history. The analysis resulted in the reconstruction of a life-near picture of the hystricognath stem species pattern with high explanatory power in terms of changes in space and time and their interdependence with biodiversity.

From reactive to proactive banking : connecting with customers with context-aware mobile technology

Mobile technology has been employed in banking for already two decades. However, its significance this far has been modest. It is expected that the industry will change a lot in the future. Elements of this change include tightening of competition, considering customer’s individual and changing needs, becoming involved in customer’s life and being where customers are. The goal of this study is to explore these fields with regard to Finnish banking as well as investigate selected consumers’ views towards this kind of new service approach. It can be divided into three questions: • What kinds of mobile services does the Finnish banking industry currently offer for consumers and what expectations do experts and consumers have towards them? o What is consumers’ attitude towards a context-aware service approach in the banking industry and what are the suggested tools for it? o What factors define clients’ adoption intentions towards the new context-aware service approach? Which factors do they consider most important? In order to create the framework for the study, both Finnish and foreign scientific and professional literature considering evolution of the industry and innovation adoption has been used. The empirical part of the study consists of 11 interviews, including 6 expert interviews and 5 consumer interviews. The results show that the selected consumers reacted very positively to the suggested new service approach that considers them as a person and aims at simplifying their banking. The consumers appreciated especially solutions that simplified their everyday banking. Also proactive actions from a bank was considered important especially in everyday banking, as long as the customer was able to define the amount and way of contacts he received. According to the findings banks should aim at supporting their customers more than they do now. However, they also need to pay attention to not irritate their customers by excessive contacts. Banks should also open-mindedly introduce new technologies to their customers. Key words

Magnetic Resocance Imaging Methods in the Follow-up of Multiple Sclerosis and in Farby Disease

Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disorder of the central nervous system. MS is the most common disabling central nervous system (CNS) disease of young adults in the Western world. In Finland, the prevalence of MS ranges between 1/1000 and 2/1000 in different areas. Fabry disease (FD) is a rare hereditary metabolic disease due to mutation in a single gene coding α-galactosidase A (alpha-gal A) enzyme. It leads to multi-organ pathology, including cerebrovascular disease. Currently there are 44 patients with diagnosed FD in Finland. Magnetic resonance imaging (MRI) is commonly used in the diagnostics and follow-up of these diseases. The disease activity can be demonstrated by occurrence of new or Gadolinium (Gd)-enhancing lesions in routine studies. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced MR sequences which can reveal pathologies in brain regions which appear normal on conventional MR images in several CNS diseases. The main focus in this study was to reveal whether whole brain apparent diffusion coefficient (ADC) analysis can be used to demonstrate MS disease activity. MS patients were investigated before and after delivery and before and after initiation of diseasemodifying treatment (DMT). In FD, DTI was used to reveal possible microstructural alterations at early timepoints when excessive signs of cerebrovascular disease are not yet visible in conventional MR sequences. Our clinical and MRI findings at 1.5T indicated that post-partum activation of the disease is an early and common phenomenon amongst mothers with MS. MRI seems to be a more sensitive method for assessing MS disease activity than the recording of relapses. However, whole brain ADC histogram analysis is of limited value in the follow-up of inflammatory conditions in a pregnancy-related setting because the pregnancy-related physiological effects on ADC overwhelm the alterations in ADC associated with MS pathology in brain tissue areas which appear normal on conventional MRI sequences. DTI reveals signs of microstructural damage in brain white matter of FD patients before excessive white matter lesion load can be observed on conventional MR scans. DTI could offer a valuable tool for monitoring the possible effects of enzyme replacement therapy in FD.

Individual dietary counselling during and after pregnancy: Impact on diet and body weight

In Finland, maternity and child health clinics play a key role in promoting health in young families. Currently, obesity causes the greatest challenges to clinics. In obese pregnant women, an increased risk for metabolic diseases exist which can affect both the mother and child. The purpose of this thesis was to explore the role of dietary counselling: in Finnish health clinics; in the regulation of dietary intake; and in affecting the body weight of women. The main aim was to test the effect of dietary counselling and probiotic intervention on dietary intake and maternal body weight during and after pregnancy. In addition to dietary counselling, the effect of other factors, such as eating behaviour on dietary intake and body weight control after pregnancy was assessed. Another aim was also to evaluate dietary counselling practices by nurses (n = 327) in Finnish health clinics assessed by a questionnaire. At the beginning of the pregnancy, women (n = 256) enrolled in a dietary intervention study, were randomised into three groups. One group received dietary counselling with probiotics, one had counselling with placebo and the third group was the control group. The control group consisted of women whom did not receive counselling and took placebo. Probiotics and placebo supplements were used until the end of exclusive breastfeeding or six months after pregnancy. Women were followed from early pregnancy up to four years after pregnancy. Follow-up visits took place three times during pregnancy, at one and six months, and one, two and four years after pregnancy. Dietary counselling, provided by a nutritionist, aimed to influence the quality of dietary fat intake. Dietary counselling is important to provide in clinics, as determined by the nurses, and these nurses expressed a want to improve their own nutritional knowledge through education. The nurses had varying knowledge of current dietary recommendations. Dietary counselling for women during and after pregnancy resulted in beneficial changes in dietary intake up to one year after pregnancy and body weight and waist circumference up to four years after pregnancy. Probiotics had a beneficial effect together with dietary counselling on waist circumference until one year after pregnancy, but not throughout the long term, four years after pregnancy. Other factors, such as eating behaviour, associated with dietary intake and body weight control after pregnancy. Specifically, dietary recommendations are reached amongst women whom had high cognitive restraint in their eating behaviour and did not demonstrate uncontrolled eating. Overweight women more frequently emotionally ate compared to normal weight women and women with central adiposity related more frequently to having an uncontrolled eating behaviour than women with normal waist circumference. In addition, being overweight prior to pregnancy and excessive weight gain during pregnancy associated with increased body weight retention after pregnancy. This study showed that individual dietary counselling is useful in influencing dietary intake which adheres to dietary recommendations and this counselling influences, favourably, body weight after pregnancy. Especially, women with the risk for weight retention, such as women who have emotional and uncontrolled eating behaviours, who were overweight prior to pregnancy or those who had excessive weight gain during pregnancy, may benefit from individual dietary counselling. This study underscores the need to develop dietary counselling practices for pregnant women and their follow-up after pregnancy in Finnish health clinics. These practices include increasing the efficacy of the counselling such as collaboration with families, having knowledgable health professionals and having sufficient resources.