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Background: Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. Methods: Biopsies from 262 children and 99 adults with IgA vasculitis nephritis (N=361) from 23 centers in North America, Europe and Asia were independently scored by 3 pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients (N=309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using Latent Class Mixed Models (LCMM) to identify classes of eGFR trajectories over a median follow-up of 2.7 years (IQR 1.2, 5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. Results: M, E, T and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by LCMM, one with initial improvement in eGFR followed by a late decline (Class 1, N=91) and another with stable eGFR (Class 2, N=218). Class 1 was associated with a higher risk of an established kidney outcome (time to >30% decline in eGFR or kidney failure, HR 5.84, 95%CI 2.37, 14.4). Among MEST-C scores, only E1 was associated with Class 1 by multivariable analysis. Other factors associated with Class 1 were age <18 years, male sex, lower eGFR at biopsy, and extrarenal non-cutaneous disease. Fibrous crescents without active changes were associated with Class 2. Conclusions: Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors, and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the ISKDC classification..

Emergency laparotomy (EL) is one of the most common emergency gastrointestinal procedures. A limited number of studies focus on the onset of postoperative complications, long-term mortality and the impact of preoperative quality of life (QoL) on the rate of postoperative complications after EL. This thesis examined the factors associated with postoperative complications after EL as well as their impact on short- and long-term outcomes. In addition, this thesis assessed whether the preoperative QoL affects the rate of postoperative complications. The thesis consists of one prospective and three retrospective studies. Overall, these studies comprised a total of 1 299 EL patients operated during 2005–2022 at Oulu University Hospital, Finland. The QoL before EL was evaluated using the RAND-36 questionnaire. Patients with postoperative complications reported lower general health in RAND-36 domains than patients without complications. Medical complications occurred mainly in the early postoperative phase while operation-related complications occurred later. Of 674 EL patients, 50% had medical complications and 30% had operation-related complications. In multivariate analysis, patient-related factors such as advanced age, high ASA and preoperative CRP and low albumin were risk factors for medical complications. Patients with medical complications had higher 30-day mortality than patients with operation-related complications (17.2% vs. 13.5%). Both short- and long-term mortality was significantly worse in EL patients with postoperative complications compared to patients without complications: 30-day mortality 15.9% vs. 5.3%, 90-day mortality 24.7% vs. 8.4%, and 2-year mortality 39.3% vs. 17.5%. In multivariate analysis, high ASA and CCI scores and longer duration of operation were associated with mortality after EL in patients surviving more than 90 days. EL patients who required ICU treatment within 48 hours of surgery had high mortality rates; the 5-year mortalit, Tiivistelmä Päivystyslaparotomia on yksi yleisimmistä yleiskirurgisista toimenpiteistä. Päivystyslaparotomian jälkeisten komplikaatioiden ilmaantuvuudesta ja leikkausta edeltävän elämänlaadun vaikutuksesta komplikaatioihin on niukasti aiempaa tutkimusta. Tässä väitöskirjatyössä tarkasteltiin päivystyslaparotomian jälkeisiä komplikaatioita ja niiden vaikutusta lyhyen- ja pitkän aikavälin ennusteeseen. Lisäksi arvioitiin, vaikuttaako leikkausta edeltävä elämänlaatu komplikaatioiden ilmaantuvuuteen. Väitöskirjatyö koostuu yhdestä prospektiivisesta ja kolmesta retrospektiivisestä tutkimuksesta. Tutkimukseen kuului 1 299 vuosina 2005–2022 Oulun yliopistollisessa sairaalassa leikattua päivystyslaparotomiapotilasta. Elämänlaatua ennen päivystyslaparatomiaa arvioitiin käyttämällä RAND-36-kyselyä. Potilaat, jotka saivat leikkauksen jälkeisen komplikaation, raportoivat heikomman yleisen terveyden RAND-36-kyselyssä kuin ilman komplikaatiota toipuneet. Ei-kirurgiset komplikaatiot ilmaantuivat pääosin varhaisvaiheessa ja kirurgiset komplikaatiot myöhäisvaiheessa. 674 päivystyslaparotomiapotilaasta 50 %:lla esiintyi ei-kirurgisia komplikaatioita ja 30 %:lla kirurgisia komplikaatioita. Monimuuttujamallissa ei-kirurgisten komplikaatioiden riskitekijöitä olivat potilaaseen liittyvät tekijät, kuten ikä, korkea ASA ja leikkausta edeltävä CRP sekä matala albumiini. Potilailla, joille ilmaantui ei-kirurgisia komplikaatioita, oli korkeampi 30 päivän kuolleisuus kuin potilailla, joilla oli kirurgisia komplikaatioita (17,2 % vs. 13,5 %). Sekä lyhyt- että pitkäaikainen kuolleisuus oli korkeampi potilailla, joille ilmaantui komplikaatioita verrattuna potilaisiin, joille ei tullut komplikaatiota: 30 päivän kuolleisuus 15,9 % vs. 5,3 % ja 90 päivän kuolleisuus 24,7 % vs. 8,4 %, ja 2 vuoden kuolleisuus 39,3 % vs. 17,5 %. Monimuuttujamallissa kuolleisuuden riskitekijöitä yli 90 päivää leikkauksen jälkeen eläneillä potilailla oli korkea ASA, korkeat CCI pisteet ja pidempi leikkauksen kesto. Tehoh

The siblings of children with mental disorders are more likely to experience mental health issues themselves, but there has been a lack of sibling studies on selective mutism (SM). The aim of this population-based study was to use national registers to examine associations between children with SM and diagnoses of various mental disorder in their siblings. All singleton children born in Finland from 1987 to 2009, and diagnosed with SM from 1998 to 2012, were identified from national health registers and matched with four controls by age and sex. Their biological siblings and parents were identified using national registries and the diagnostic information on the siblings of the subjects and controls was obtained. The final analyses comprised 658 children with SM and their 1661 siblings and 2092 controls with 4120 siblings. The analyses were conducted using generalized estimating equations. Mental disorders were more common among the siblings of the children with SM than among the siblings of the controls. The strongest associations were observed for childhood emotional disorders and autism spectrum disorders after the data were adjusted for covariates and comorbid diagnoses among SM subjects. The final model showed associations between SM and a wide range of disorders in siblings, with strongest associations with disorders that usually have their onset during childhood. Our finding showed that SM clustered with other mental disorders in siblings and this requires further research, especially the association between SM and autism spectrum disorders. Strong associations with childhood onset disorders may indicate shared etiologies.

Purpose: Outcomes after emergency laparotomy (EL) are poor. These patients are often admitted to an intensive care unit (ICU). This study explored outcomes in patients who were admitted to an ICU within 48 h after EL. Materials and Methods: This retrospective single-center registry study included all patients over 16 years of age that underwent an EL and were admitted to an ICU within 48 h after surgery in Oulu University Hospital, Finland between January 2005 and May 2015. Survival was followed until the end of 2019. Results: We included 525 patients. Hospital mortality was 13.3%, 30-day mortality was 17.3%, 90-day mortality was 24.2%, 1-year mortality was 33.0%, and 5-year mortality was 59.4%. Survivors were younger (57 [45–70] years) than the non-survivors (73 [62–80] years; p < .001). According to the Cox regression model, death during the follow-up was associated with age, APACHE II-score, lower postoperative CRP levels and platelet count of the first postoperative day, and the admission from the post-anesthesia care unit (PACU) to the ICU instead of direct ICU admission. Conclusion: Age, high APACHE II-score, low CRP and platelet count, and admission from the PACU to the ICU associated with mortality after EL in patients admitted to an ICU within 48 h after EL.

Background: Emergency laparotomy (EL) is a common urgent surgical procedure with high risk for postoperative complications. Complications impair the prognosis and prolong the hospital stay. This study explored the incidence and distribution of complications and their impact on short-term mortality after EL. Methods: This was a retrospective single-center register-based cohort study of 674 adults undergoing midline EL between May 2015 and December 2017. The primary outcome was operation-related or medical complication after EL. The secondary outcome was mortality in 90-day follow-up. Multivariate logistic regression analyses were used to identify independent risk factors for complications. Results: A total of 389 (58%) patients developed complications after EL, including 215 (32%) patients with operation-related complications and 361 (54%) patients with medical complications. Most of the complications were Clavien-Dindo classification type 4b (28%) and type 2 (22%). Operation-related complications occurred later compared to medical complications. Respiratory complications were the most common medical complications, and infections were the most common operation-related complications. The 30- and 90-day mortalities were higher in both the medical (17.2%, 26.2%) and operation-related complication groups (13.5%, 24.2%) compared to patients without complications (10.5% and 4.8%, 14.8% and 8.0%). Low albumin, high surgical urgency, excessive alcohol consumption and medical complications were associated with operation-related complications. Older age, high ASA class and operation-related complications were associated with medical complications. Conclusions: This study demonstrated that EL is associated with a high risk of complications and poor short-term outcome. Complications impair the prognosis regardless of which kind of EL is in question.

Background: Emergency laparotomy (EL) is a common surgical operation with poor outcomes. Patients undergoing EL are often frail and have chronic comorbidities, but studies focused on the long-term outcomes after EL are lacking. The aim of the present study was to examine the long-term mortality after EL. Methods: We conducted a retrospective single-center cohort study of 674 adults undergoing midline EL between May 2015 and December 2017. The follow-up lasted until September 2020. The primary outcome was 2-year mortality after surgery. The secondary outcome was factors associated with mortality during follow-up. Results: A total of 554 (82%) patients survived > 90 days after EL and were included in the analysis. Of these patients, 120 (18%) died during the follow-up. The survivors were younger than the non-survivors (median [IQR] 64 [49–74] vs. 71 [63–80] years, p < 0.001). In a Cox regression model, death during follow-up was associated with longer duration of operation (OR 2.21 [95% CI 1.27–3.83]), higher ASA classification (OR 2.37 [1.15–4.88]), higher CCI score (OR 4.74 [3.15–7.14]), and postoperative medical complications (OR 1.61 [1.05–2.47]). Conclusions: Patient-related factors, such as higher ASA classification and CCI score, were the most remarkable factors associated with poor long-term outcome and mortality after EL.

Biallelic loss-of-function variants in the SMG9 gene, encoding a regulatory subunit of the mRNA nonsense-mediated decay (NMD) machinery, are reported to cause heart and brain malformation syndrome. Here we report five patients from three unrelated families with intellectual disability (ID) and a novel pathogenic SMG9 c.551 T > C p.(Val184Ala) homozygous missense variant, identified using exome sequencing. Sanger sequencing confirmed recessive segregation in each family. SMG9 c.551T > C p.(Val184Ala) is most likely an autozygous variant identical by descent. Characteristic clinical findings in patients were mild to moderate ID, intention tremor, pyramidal signs, dyspraxia, and ocular manifestations. We used RNA sequencing of patients and age- and sex-matched healthy controls to assess the effect of the variant. RNA sequencing revealed that the SMG9 c.551T > C variant did not affect the splicing or expression level of SMG9 gene products, and allele-specific expression analysis did not provide evidence that the nonsense mRNA-induced NMD was affected. Differential gene expression analysis identified prevalent upregulation of genes in patients, including the genes SMOX, OSBP2, GPX3, and ZNF155. These findings suggest that normal SMG9 function may be involved in transcriptional regulation without affecting nonsense mRNA-induced NMD. In conclusion, we demonstrate that the SMG9 c.551T > C missense variant causes a neurodevelopmental disorder and impacts gene expression. NMD components have roles beyond aberrant mRNA degradation that are crucial for neurocognitive development.

Purpose: Adequate nutrition after major abdominal surgery is associated with less postoperative complications and shorter hospital length of stay (LOS) after elective procedures, but there is a lack of studies focusing on the adequacy of nutrition after emergency laparotomies (EL). The aim of the present study was to investigate nutrition adequacy after EL in surgical ward. Methods: The data from 405 adult patients who had undergone emergency laparotomy in Oulu University Hospital (OUH) between years 2015 and 2017 were analyzed retrospectively. Nutrition delivery and complications during first 10 days after the operation were evaluated. Results: There was a total of 218 (53.8%) patients who were able to reach cumulative 80% nutrition adequacy during the first 10 postoperative days. Patients with adequate nutrition (> 80% of calculated calories) met the nutritional goals by the second postoperative day, whereas patients with low nutrition delivery (< 80% of calculated calories) increased their caloric intake during the first 5 postoperative days without reaching the 80% level. In multivariate analysis, postoperative ileus [4.31 (2.15–8.62), P < 0.001], loss of appetite [3.59 (2.18–5.93), P < 0.001] and higher individual energy demand [1.004 (1.003–1.006), P = 0.001] were associated with not reaching the 80% nutrition adequacy. Conclusions: Inadequate nutrition delivery is common during the immediate postoperative period after EL. Oral nutrition is the most efficient way to commence nutrition in this patient group in surgical ward. Nutritional support should be closely monitored for those patients unable to eat.

Background: In Henoch–Schönlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable. Methods: We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up. Results: Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p < 0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053). Conclusions: Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.

The unmanned aircraft systems (UAS) are commonly used for aerial photography, express delivery for packets or video monitoring. The UAS technology can help responding to the growing demands of the frequency monitoring by national radiocommunication authorities (NRAs). This article presents a practical usage trial of an unmanned aircraft for monitoring the spectrum usage and finding the interference location. The monitoring of spectrum usage is one part of the NRAs’ process for guarantee user compliance with radio license conditions. Finding illegal or malfunctioning transmitters is a challenging task especially in urban environment, due to multi-path propagation conditions. This study focuses on practical assessment of the method for determining accurate location of radio frequency interference sources from the buildings using the UAS technology. The practicability of the UAS technology usage in spectrum monitoring activities was under the evaluation. This study showed promising results that UAS with the measurement equipment setup suits NRAs’ as a tool for mobile monitoring on the air.

This study presents the usage of unmanned aircraft for site survey and antenna pattern measurements in-situ in mobile networks. The site survey is one part of the verification and optimization process of the network operator. Mobile network operators’ responsibility is to ensure the broadly available, reliable network series that are essential for customer experience. Technically that means mobile network coverage of the desired area without holes and with good capacity. The operator performs network planning in order to optimize coverage and capacity. It is essential to know the antenna pattern to plan and design an effective and efficient mobile network. Antenna manufacturers provide antenna radiation patterns measured in the standard anechoic chamber. Understanding how real site implementation differs from the laboratory measurements is also crucial. This study focuses on developing in-situ antenna measurements for the antenna patterns recorded in the laboratory. The evaluation of antenna radiation patterns in a real environment will provide additional information about what kind of effect the antenna site mast, installation, and antenna performance parameters will have on the theoretical radiation pattern.

This paper has two main objectives. First, it describes the practical challenges of field trials and proposes a developed test method. Second, the test method is used to compare the uplink (UL) performance with different antenna technologies when user equipment (UE) does not have a line of sight (LOS) to the evolved node B. Both passive and active antenna configurations were used in the performance evaluation. Modern cellular networks have high demands for capacity, reliability, and availability. The verification of a network’s configuration and technological features is essential to guarantee network performance, and the performance of a network must be verified by the laboratory testing or field trials; such trials produce the experimental knowledge of technology features and configurations. Technological and environmental factors must also be considered before performing mobile network field testing. This paper showed that moving UE produces more reliable and repeatable results than measurements with stationary UE. Our antenna configuration comparison study revealed that in the UL direction, active antenna system beam control could significantly increase the UL capacity in non-LOS conditions.

Background: Sepsis delays wound re-epithelialization. In this study we explored the effect of human sepsis sera as well as the effects of cytokines, growth factors and exosomes of sepsis sera treated normal fibroblasts (NF) on keratinocyte migration and proliferation in vitro. Methods: Serum samples were taken on days 1, 4, and 9 from 44 patients diagnosed with severe sepsis, and from 14 matching healthy controls. We evaluated the effects of sepsis serum with or without TNF-α, EGF, EGF receptor inhibitor or exosomes of sepsis sera treated NF on human keratinocyte (HaCaT) proliferation (BrdU assay), viability (MTT assay), and migration (horizontal wound healing model). Cytokine levels of sepsis and healthy sera were measured by multiplex assay. Comparisons between groups were carried out using SPSS statistics and P < 0.05 was considered significant. Results: Severe-sepsis sera collected on days 1, 4, and 9 reduced keratinocyte proliferation by 6% (P = 0.005), 20% (P = 0.001), and 18% (P = 0.002), respectively, compared to control sera. Cell viability in cultures exposed to sepsis sera from days 4 and 9 was reduced by 38% (P = 0.01) and 58% (P < 0.001), respectively. Open-surface wounds exposed to sepsis sera from days 1 and 4 were larger than those exposed to sera from healthy controls (60 vs. 31%, P = 0.034 and 66 vs. 31%, P = 0.023, respectively). Exosomes of sepsis or healthy sera treated NF inhibited keratinocyte migration. We detected higher serum levels of cytokines TNF-α (5.7 vs. 0.7 pg/ml, P < 0.001), IL-6 (24.8 vs. 3.8 pg/ml, P < 0.001), IL-10 (30.0 vs. 11.9 pg/ml, P = 0.040), and VEGF (177.9 vs. 48.1 pg/ml, P = 0.018) in sepsis sera. Levels of EGF were significantly lower in sepsis sera than in that of healthy controls (6.5 vs. 115.6 pg/ml, P < 0.001). Sepsis serum supplemented with EGF 5 ng/ml and TNF-α in all concentrations improved keratinocyte migration. Conclusions: Keratinocyte viability, proliferation and migration were reduce

The aim of this paper is to introduce the measurement method for challenging Non-Line of Sight (NLOS) conditions in mobile networks. The need to develop the measurement method appeared LTE (Long Term Evolution) uplink (UL) performance with different antenna technologies when receiving NLOS signal in field tests. Many challenges appeared during the study. This paper introduces the challenges and presents solution.

Radio coverage is a crucial component in any radio network design and deployment. In order to develop a design and deployment tool, we studied and utilized two different measurement approaches suitable for estimating indoor WiFi coverage. One of the tested approaches uses a handheld spectrum analyzer, while the other is a protocol-dependent method using standard Windows API calls. The applicability of these approaches is shown and the pros and cons of both measurement approaches are discussed based on visualization of the examples and comparison of the results. An analysis of the degree of dynamic radio channel effects for the observed differences between the two methods is also presented.

It is a generally accepted dogma that sepsis disturbs skin function and wound healing, but surprisingly there is only remote pathophysiological evidence available behind that presumption. As the skin is the largest defensive barrier, the skin dysfunction in severe sepsis deserves more attention. In this study, the suction blister model was used to create experimental wounds. The study population included 44 patients with severe sepsis and 15 controls. The blister fluid was collected to analyse cytokine profile of the skin. The transepidermal water loss and blood flow from the wound were measured. A 4mm biopsy was taken under local anaesthesia on the first and the eighth day of the study from the healthy looking skin. Then 15 healing suction blisters were excised. Serum samples were also collected on the first day of the study. The barrier restoration was diminished, and the inflammation in the wound was more intense in severe sepsis than in the controls. The expression of the basement membrane components Laminin-332 and type IV collagen decreased during the septic disease, but increased over the next 3 months without achieving the level oft he controls. The expression of tight junction proteins remained nearly intact in the healing wound in severe sepsis compared to the controls. The expression of occludin on the leading edge of the migrating keratinocytes was more restricted and late in severe sepsis compared to the controls. The levels of the tumour necrosis factor (TNF), interleukin-10 (IL-10) and IL-6 in skin blister fluid were higher in the sepsis compared to controls. The blister fluid and serum cytokine response in the sepsis differed since the levels of epidermal growth factor, vascular endothelial growth factor, TNF and basic fibroblastic growth factor (bFGF) in the blister fluid did not correlate with the levels of serum. The septic patients with multiple organ failure had higher levels of several cytokines than patients without organ failure. Sur, Tiivistelmä Sepsiksen ajatellaan heikentävän haavanparanemista, mutta tieteellistä näyttöä on niukasti. Iholla on keskeinen osa elimistön puolustuksessa ja tasapainon ylläpidossa, joten sen toiminnan häiriintyminen systeemisessä tulehduksessa ansaitsee suuremman huomion. Imurakkulahaavat tehtiin 44 septiselle potilaalle ja 15 kontrollille. Haavoista mitattiin veden haihtumista ja veren virtausta sekä otettiin imurakkulaneste näytteeksi sytokiinimäärityksiä varten. Tutkimuksen ensimmäisenä ja kahdeksantena päivänä otettiin 4mm biopsiat terveeltä iholta ja 15 potilaalta poistettiin näytteeksi paraneva imurakkulahaava. Seeruminäytteet otettiin tutkimuksen ensimmäisenä päivänä. Veden haihtuminen haavalta oli voimakkaampaa eli ihon barrierin palautuminen oli hidastunut septisillä potilailla verrattuna kontrolleihin. Haavassa havaittu tulehdus oli sepsiksessä voimakkaampi. Tyvikalvon komponenttien Laminiini-332:n ja tyypin IV kollageenin ilmentyminen oli vähäisempää sepsiksen aikana ja lisääntyi 3kk kohdalla, mutta ei kuitenkaan saavuttanut kontrollien tasoa. Tiivisliitosproteiinien ilmentyminen oli lähes muuttumatonta sepsiksessä kontrolleihin verrattuna. Okludiinin ilmentyminen sen sijaan paranevassa haavassa vaeltavien keratinosyyttien etureunassa oli rajoittuneempaa ja myöhäisempää sepsiksessä kuin kontrolleilla. Sytokiineistä tuumorinekroositekijä (TNF), interleukiini-10 (IL-10) ja IL-6 olivat koholla imurakkulanesteessä verrattuna kontrolleihin. Epidermaalinen kasvutekijä, verisuonten endoteelikasvutekijä, TNF ja perusfibroplastinen kasvutekijä (bFGF) pitoisuudet rakkulanesteessä erosivat seerumin pitoisuuksista eli ihon sytokiiniprofiili erosi systeemisestä sytokiiniprofiilista. Potilailla, joilla oli monielinvaurio, todettiin korkeampia sytokiinipitoisuuksia. Potilailla, jotka menehtyivät 30 vrk kuluessa, oli korkeammat pitoisuudet IL-10 ja bFGF rakkulanesteessä. Tämä tutkimus tarjoaa uutta tietoa ihosta ja haavanparanemisesta sepiksessä. Tulosten perusteella void