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OBJECTIVES Sonographic artifacts known as B-lines can been used to estimate alterations of lung parenchyma. Multiple B-lines on sonography are seen in congestive heart disease, interstitial lung disease, respiratory infections, and neonates. The aim of this study was to compare the amount of B-lines on sonography to the extent of parenchymal changes on computed tomography (CT) in children. METHODS Lung sonography was performed on 60 patients aged 18 years and younger referred for chest CT at our institution. B-lines were counted from 5 anterolateral intercostal spaces bilaterally. The CT findings were documented and graded as absent, minimal, partial, or complete. RESULTS The number of B-lines on sonography increased consistently with the growing extent of parenchymal changes on CT. The differences in the B-line counts between the patients grouped according to the extent of parenchymal changes on CT were statistically significant except between patients with minimal and no changes (P < .01 Kruskal-Wallis and Tukey tests). CONCLUSIONS The number of B-lines on sonography correlates with the extent of parenchymal changes on CT. Various parenchymal changes were seen in patients with B-lines on sonography. B-lines were more frequently seen in patients with no changes on CT when imaged during general anesthesia.

Artikkelissa tarkastellaan Martti Rapolan (1891–1972) sanakokoelmaa. Rapola tutki murteiden ohessa Ruotsin vallan ajan kirjasuomea uransa alusta saakka, mutta hän alkoi julkaista tutkimuksia 1800-luvun kielestä vasta 1930-luvulla saatuaan Suomen kirjakielen kehitys -teoksensa (1933) ensimmäisen osan julki. Vuosikymmenen jälkipuoliskolla hän alkoi koota aineistoa, josta vähitellen muotoutui merkitysten mukaan jaoteltu sanakokoelma. Aktiivisinta tämän kokoelman keruu ja hyödyntäminen tutkimuksessa näyttäisi olleen sotavuosina 1940-luvun alkupuoliskolla, jolloin julkiset arkistokokoelmat eivät olleet käytettävissä. Näkemyksensä 1800-luvun kielen kehityksestä Rapola kiteytti vuonna 1945 julkaisemansa suppean Vanha kirjasuomi -teoksen loppulukuun. Tätä hän ei teoksen myöhemmissä painoksissa enää muuttanut, vaikka hän julkaisikin laajimmat 1800-luvun kieltä koskevat erityistutkimuksensa vasta tämän jälkeen. Rapola hyödynsi sanakokoelmaansa vielä julkaistessaan valikoiman Sanastomme ensiesiintymiä Agricolasta Yrjö-Koskiseen (1960), mutta tässä teoksessa hän tarkasteli otsikon mukaisesti vain kirjasuomeen vakiintunutta sanastoa, joten suurin osa hänen kokoamastaan aineistosta jäi hyödyntämättä. Rapolan 1800-luvun sanakokoelman on arvioitu käsittävän 44 000 sanalippua. Näistä pieni osa on poimintoja suomen murteista, vanhasta kirjasuomesta ja 1900-luvun kielestä, mutta valtaosa lipuista on poimintoja erilaisista 1800-luvun lähteistä: sanakirjoista ja sanastoista, kirjoista ja lehtiartikkeleista, (etupäässä julkaistujen editioiden kautta) hiukan myös kirjeistä ja päiväkirjoista. Lähteitä on kaikkiaan lähes 900. Niistä suurin osa on 1820–1860-luvuilta; etenkin vuosisadan äärivuosikymmeniltä lähteitä on niukasti. Rapola keskittyi poimimaan kirjasuomen itäisten kehittäjien tuotantoa. Nimekkeiden määrän pohjalta aineistossa parhaiten edustettuina ovat Elias Lönnrot, August Ahlqvist ja Volmar Schildt-Kilpinen, näitä harvinaisempina Reinhold von Becker, Carl Axel Gottlund ja eräät Suomettaren toimittajat. Länsisuomalaisia kielenkäyttäjiä Rapola on poiminut selvästi vähemmän, mikä liittyy osittain siihen, että hän on tarkastellut hyvin niukasti vanhan läntisen kirjakielen suorinta jatkumoa edustavaa 1800-luvun hengellistä kirjasuomea. Poimintojensa niukkuuden vuoksi kirjasuomen pohjoisten kehittäjien, kuten Carl Niclas Keckmanin ja Klaus Johan Kemellin, merkitys ei Rapolalle auennut eikä hän täysin ymmärtänyt hämäläisen Jaakko Juteininkaan roolia. Näin Rapolan sanakokoelman painotukset muokkasivat 1800-luvun kirjasuomesta hänen tutkimustensa kautta vakiintunutta kuvaa. Tämä alkoi muuttua vasta, kun tutkimuksessa alettiin tarkastella myös sellaisia aihealueita ja henkilöitä, joita Rapola oli tutkinut vain niukasti, jos lainkaan. The 19th-century word collection of Martti Rapola, its background and influence Martti Rapola (1891–1972) conducted research on Finnish dialects and Old Literary Finnish throughout his long career. It was not until 1933, however, that he published his first study on 19th-century Finnish, after the publication of his influential book Suomen kirjakielen kehitys (‘The Development of the Finnish Literary Language’). In the late 1930s, Rapola began collecting material for what would develop into a word collection of 19th-century Finnish based on word meaning. This collection is the focus of this article. The most active phase in the collection and study of this material seems to have been during the war years 1940–1945, when public archive collections were not at his disposal. In 1945 Rapola published the booklet Vanha kirjasuomi (Old Literary Finnish), in the final chapter of which he went on to formulate his ideas on the development of 19th-century Finnish as well. He did not revise his early thoughts on this subject, even though he published his most substantial studies on 19th-century Finnish in the late 1940s and the 1950s. In 1960 Rapola published Sanastomme ensiesiintymiä, a lexical selection of the first appearances of Finnish words. In this book he only dealt with words still in use, leaving the bulk of his collection unpublished. In its entirety, Rapola’s collection contains approximately 44 000 word notes. The majority of these are based on dictionaries, glossaries, books and articles published in the 19th century, and only a small fraction contains either earlier or later literary language, or material from unpublished sources such as diaries and letters. The list of sources consists of nearly 900 bibliographical entries. These are predominantly from the years 1820–1870; thus, both the beginning and the end of the century are sparsely represented. Rapola focused largely on works by 19th-century representatives of eastern Finnish dialects. Authors like Elias Lönnrot, August Ahlqvist and Volmar Schildt-Kilpinen are very well represented in the collection, while there is less material from Reinhold von Becker, Carl Axel Gottlund and some of the editors of the magazine Suometar. Rapola showed less interest in the works of western dialect representatives, especially for religious literature, which had a long tradition in Western Finland. Due to the scarcity of western material, he failed in his studies to understand the role of the Tavastian author Jaakko Juteini as well as the significance of northern Finnish writers. It was not until scholars started to pay attention to individuals and themes largely overlooked by Rapola that views on 19th-century Finnish began to reach a new stage of development.

Background: Large myocardial infarction (MI) is associated with adverse left ventricular (LV) remodeling (LVR). We studied the nature of LVR, with specific attention to non-transmural MIs, and the association of peak CK-MB with recovery and chronic phase scar size and LVR. Methods: Altogether 41 patients underwent prospectively repeated cardiovascular magnetic resonance at a median of 22 (interquartile range 9-29) days and 10 (8-16) months after the first revascularized MI. Transmural MI was defined as >= 75% enhancement in at least one myocardial segment. Results: Peak CK-MB was 86 (40-216) mu g/L in median, while recovery and chronic phase scar size were 13 (3-23) % and 8 (2-19) %. Altogether 33 patients (81%) had a non-transmural MI. Peak CK-MB had a strong correlation with recovery and chronic scar size (r >= 0.80 for all, r >= 0.74 for non-transmural MIs; p = 0.75 for all, r >= 0.73 for non-transmural MIs; p

Gaining vascular access in a neonate during cardiopulmonary resuscitation is crucial and challenging. Intraosseous (IO) access can offer a fast and reliable method for achieving emergency access for fluids and drugs when venous access fails in a critically ill child. IO access can however result in rare, but serious adverse events including compartment syndrome and amputation. We describe a case resulting in leg amputation due to IO infusion in a neonate after resuscitation and therapeutic hypothermia. We compared 10 tibia X-rays in three age groups. The mean medullary diameter of the proximal tibia at the recommended site for IO access was 7 mm in neonate, 10 mm in 1- to 12-month-old infants, and 12 mm in 3- to 4-year-old children. This provides a narrow margin of safety for the correct positioning and the avoidance of dislodgement of the IO needle. The correct position of the IO needle should be confirmed by bone marrow aspiration and fluid bolus. Unnecessary touching of the IO needle after fixing it in place should be avoided by inserting a luer-lock catheter with a three-way stop-cock for IO drug and fluid administration. Regular observation of the circulation and possible swelling of the leg should be performed. The IO administration of inotropic infusions should also be avoided after the initial resuscitation phase. When treating with therapeutic hypothermia, it may be wise to remove the IO needle much earlier than the currently recommended 24 h because of the problems in peripheral circulation and its monitoring.

Non

As in many European countries, Finnish psychiatric services experienced a rapid process of deinstitutionalization in the 1990s. In recent decades, the decrease in numbers of psychiatric hospital beds has in several countries been found to be linked with increasing criminality among severely mentally ill individuals. It has been concluded that deinstitutionalization could be the main reason for this development.To investigate whether the prevalence of severely mentally ill persons to prison is a growing trend also in Finland.We searched for the annual data in electronic case files of all prisoners about the ICD-10 diagnostic group of the most severe psychotic disorders. We also searched for the comorbid substance use disorders. Psychotic disorders due to substance abuse only were excluded from this study.During the years 2005-2016, a rapid 10-fold increase in psychotic disorders has occurred in Finnish prisons. In 2016, 185 prisoners (5.9% of all Finnish prisoners) were diagnosed as having a psychotic disorder that was not induced by substance abuse. The causes of this dramatic change are unclear. Comorbid substance abuse disorders were detected in only 39.5% of these prisoners and therefore substance abuse can only partly explain the increasing criminality of the severely mentally ill persons. 80.5% of psychotic disorders were diagnosed in Psychiatric Hospital for prisoners and 19.5% in prison policlinic services.Trans-institutionalization has become a serious challenge for the Finnish criminal justice and mental health systems. Further studies are needed to detect the causes of this change. More specialized services for severely mentally ill persons are needed both in the community psychiatry and also inside the prison services.

Staphylococcal enterotoxins have been shown to promote lymphoma-associated immune dysregulation. This study examined changes in the skin microbiome of parapsoriasis compared with intact skin. Swab microbiome specimens were taken of the parapsoriasis lesions of 13 patients. Control samples were taken from contralateral healthy sides of the body. Microbiotas were characterized by sequencing the V1–V3 region of the 16S ribosomal RNA bacterial genes on the Illumina MiSeq platform. The most common genera in the microbiome data were Propionibacterium (27.13%), Corynebacterium (21.20%) and Staphylococcus (4.63%). Out of the Staphylococcus sequences, 39.6% represented S. epidermidis, with the rest including S. hominis, S. capitis and unidentified species. No significant differences were observed between the patients’ parapsoriasis and contralateral healthy skin or between large- and small-plaque parapsoriasis. Notable interpersonal variation was demonstrated. These results suggest that parapsoriasis is not associated with significant alterations in the cutaneous bacterial microbiome.

In vitro studies have indicated that staphylococcal enterotoxin-producing bacteria promote activation of STAT3 in malignant cutaneous lymphoma (Sezary syndrome) T cells. We investigated the skin microbiome of patch stage mycosis fungoides (MF) compared to normal skin by 16S amplicon sequencing and whole genome shotgun sequencing (WGS). Swab specimens were taken from MF patches and contralateral healthy appearing skin of 20 patients. The most common genera were Staphylococcus (30,0 %), Corynebacterium (22,3 %) Propionibacterium (5,0 %) and Streptococcus (3,0 %). Analysis of the Staphylococcus sequences (oligotyping, WGS) identified S. epidermidis (48,1 %), S. aureus (33,8 %) and S. capitis (18,0 %) and unidentified species. We observed no significant differences between the patientsu2019 lymphoma and healthy skin, but there was a notable interpersonal variation. Our results highlight the complexity of 16S and WGS methods to investigate full spectrum of microbiota in skin disease. The role of the skin microbiome in cutaneous T cell lymphoma remains uncertain and warrants further research, e.g. during disease progression.