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  • Ylikallio, Emil (Helsingin yliopisto, 2011)
    Defects in mitochondrial DNA (mtDNA) maintenance cause a range of human diseases, including autosomal dominant progressive external ophthalmoplegia (adPEO). This study aimed to clarify the molecular background of adPEO. We discovered that deoxynucleoside triphosphate (dNTP) metabolism plays a crucial in mtDNA maintenance and were thus prompted to search for therapeutic strategies based on the modulation of cellular dNTP pools or mtDNA copy number. Human mtDNA is a 16.6 kb circular molecule present in hundreds to thousands of copies per cell. mtDNA is compacted into nucleoprotein clusters called nucleoids. mtDNA maintenance diseases result from defects in nuclear encoded proteins that maintain the mtDNA. These syndromes typically afflict highly differentiated, post-mitotic tissues such as muscle and nerve, but virtually any organ can be affected. adPEO is a disease where mtDNA molecules with large-scale deletions accumulate in patients tissues, particularly in skeletal muscle. Mutations in five nuclear genes, encoding the proteins ANT1, Twinkle, POLG, POLG2 and OPA1, have previously been shown to cause adPEO. Here, we studied a large North American pedigree with adPEO, and identified a novel heterozygous mutation in the gene RRM2B, which encodes the p53R2 subunit of the enzyme ribonucleotide reductase (RNR). RNR is the rate-limiting enzyme in dNTP biosynthesis, and is required both for nuclear and mitochondrial DNA replication. The mutation results in the expression of a truncated form of p53R2, which is likely to compete with the wild-type allele. A change in enzyme function leads to defective mtDNA replication due to altered dNTP pools. Therefore, RRM2B is a novel adPEO disease gene. The importance of adequate dNTP pools and RNR function for mtDNA maintenance has been established in many organisms. In yeast, induction of RNR has previously been shown to increase mtDNA copy number, and to rescue the phenotype caused by mutations in the yeast mtDNA polymerase. To further study the role of RNR in mammalian mtDNA maintenance, we used mice that broadly overexpress the RNR subunits Rrm1, Rrm2 or p53R2. Active RNR is a heterotetramer consisting of two large subunits (Rrm1) and two small subunits (either Rrm2 or p53R2). We also created bitransgenic mice that overexpress Rrm1 together with either Rrm2 or p53R2. In contrast to the previous findings in yeast, bitransgenic RNR overexpression led to mtDNA depletion in mouse skeletal muscle, without mtDNA deletions or point mutations. The mtDNA depletion was associated with imbalanced dNTP pools. Furthermore, the mRNA expression levels of Rrm1 and p53R2 were found to correlate with mtDNA copy number in two independent mouse models, suggesting nuclear-mitochondrial cross talk with regard to mtDNA copy number. We conclude that tight regulation of RNR is needed to prevent harmful alterations in the dNTP pool balance, which can lead to disordered mtDNA maintenance. Increasing the copy number of wild-type mtDNA has been suggested as a strategy for treating PEO and other mitochondrial diseases. Only two proteins are known to cause a robust increase in mtDNA copy number when overexpressed in mice; the mitochondrial transcription factor A (TFAM), and the mitochondrial replicative helicase Twinkle. We studied the mechanisms by which Twinkle and TFAM elevate mtDNA levels, and showed that Twinkle specifically implements mtDNA synthesis. Furthermore, both Twinkle and TFAM were found to increase mtDNA content per nucleoid. Increased mtDNA content in mouse tissues correlated with an age-related accumulation of mtDNA deletions, depletion of mitochondrial transcripts, and progressive respiratory dysfunction. Simultaneous overexpression of Twinkle and TFAM led to a further increase in the mtDNA content of nucleoids, and aggravated the respiratory deficiency. These results suggested that high mtDNA levels have detrimental long-term effects in mice. These data have to be considered when developing and evaluating treatment strategies for elevating mtDNA copy number.
  • Järvinen, Elina (Helsingin yliopisto, 2008)
    In most non-mammalian vertebrates, such as fish and reptiles, teeth are replaced continuously. However, tooth replacement in most mammals, including human, takes place only once and further renewal is apparently inhibited. It is not known how tooth replacement is genetically regulated, and little is known on the physiological mechanism and evolutionary reduction of tooth replacement in mammals. In this study I have attempted to address these questions. In a rare human condition cleidocranial dysplasia, caused by a mutation in a Runt domain transcription factor Runx2, tooth replacement is continued. Runx2 mutant mice were used to investigate the molecular mechanisms of Runx2 function. Microarray analysis from dissected embryonic day 14 Runx2 mutant and wild type dental mesenchymes revealed many downstream targets of Runx2, which were validated using in situ hybridization and tissue culture methods. Wnt signaling inhibitor Dkk1 was identified as a candidate target, and in tissue culture conditions it was shown that Dkk1 is induced by FGF4 and this induction is Runx2 dependent. These experiments demonstrated a connection between Runx2, FGF and Wnt signaling in tooth development and possibly also in tooth replacement. The role of Wnt signaling in tooth replacement was further investigated by using a transgenic mouse model where Wnt signaling mediator β-catenin is continuously stabilized in dental epithelium. This stabilization led to activated Wnt signaling and to the formation of multiple enamel knots. In vitro and transplantation experiments were performed to examine the process of extra tooth formation. We showed that new teeth were continuously generated and that new teeth form from pre-existing teeth. A morphodynamic activator-inhibitor model was used to simulate enamel knot formation. By increasing the intrinsic production rate of the activator (β-catenin), the multiple enamel knot phenotype was reproduced by computer simulations. It was thus concluded that β-catenin acts as an upstream activator of enamel knots, closely linking Wnt signaling to the regulation of tooth renewal. As mice do not normally replace teeth, we used other model animals to investigate the physiological and genetic mechanisms of tooth replacement. Sorex araneus, the common shrew was earlier reported to have non-functional tooth replacement in all antemolar tooth positions. We showed by histological and gene expression studies that there is tooth replacement only in one position, the premolar 4 and that the deciduous tooth is diminished in size and disappears during embryogenesis without becoming functional. The growth rates of deciduous and permanent premolar 4 were measured and it was shown by competence inference that the early initiation of the replacement tooth in relation to the developmental stage of the deciduous tooth led to the inhibition of deciduous tooth morphogenesis. It was concluded that the evolutionary loss of deciduous teeth may involve the early activation of replacement teeth, which in turn suppress their predecessors. Mustela putorius furo, the ferret, has a dentition that resembles that of the human as ferrets have teeth that belong to all four tooth families, and all the antemolar teeth are replaced once. To investigate the replacement mechanism, histological serial sections from different embryonic stages were analyzed. It was noticed that tooth replacement is a process which involves the growth and detachment of the dental lamina from the lingual cervical loop of the deciduous tooth. Detachment of the deciduous tooth leads to a free successional dental lamina, which grows deeper into the mesenchyme, and later buds the replacement tooth. A careful 3D analysis of serial histological sections was performed and it was shown that replacement teeth are initiated from the successional dental lamina and not from the epithelium of the deciduous tooth. The molecular regulation of tooth replacement was studied and it was shown by examination of expression patterns of candidate regulatory genes that BMP/Wnt inhibitor Sostdc1 was strongly expressed in the buccal aspect of the dental lamina, and in the intersection between the detaching deciduous tooth and the successional dental lamina, suggesting a role for Sostdc1 in the process of detachment. Shh was expressed in the enamel knot and in the inner enamel epithelium in both generations of teeth supporting the view that the morphogenesis of both generations of teeth is regulated by similar mechanisms. In summary, histological and molecular studies on different model animals and transgenic mouse models were used to investigate tooth replacement. This thesis work has significantly contributed to the knowledge on the physiological mechanisms and molecular regulation of tooth replacement and its evolutionary suppression in mammals.
  • Syväranta, Suvi (Helsingin yliopisto, 2013)
    Aortic valve stenosis (AVS) is the most common valvular disease in Western countries. Pharmacological prevention of AVS having proved unsuccessful, its current treatment is still valve replacement. The etiology of AVS is multifactorial, both genetic and external risk factors predisposing to the active pathological process eventually leading to clinically manifest stenosis. Histological features of the disease resemble those of atherosclerosis, including the accumulation and modification of lipoproteins, inflammation, extracellular matrix remodeling, and calcification. Furthermore, valvular interstitial cells undergo phenotypic differentiation into actively proliferating myofibroblasts, which contribute to the local inflammatory response as well as extracellular matrix remodeling in stenotic aortic valves. Blood vessels also grow into the normally avascular valve leaflets already in the early stages of the disease. This thesis aimed at elucidating the mechanisms behind the pathological neovascularization of the stenotic aortic valves. Furthermore, we characterized valvular lymphangiogenesis and investigated potential factors contributing to the balance between valvular angiogenesis and lymphangiogenesis, focusing on the role of valvular myofibroblasts and mast cells. For this purpose, we studied a total of 117 stenotic valves obtained at valve replacement surgery, and 49 control valves obtained at cardiac transplantations, at valve replacement surgery due to aortic valve regurgitation, or from deceased organ donors whose hearts were unsuitable for use as grafts. The valve leaflets were either used freshly for myofibroblast cell culture or frozen for e.g. PCR and immunohistochemical analyses. First, we assessed the adverse extracellular matrix remodeling of stenotic aortic valves, a process necessary for angiogenic sprouting to occur. We found that the mRNA expression levels of cathepsins S, K, and V, and their inhibitor cystatin C were higher in stenotic aortic valves than in control valves. Furthermore, the total activity of such cathepsins was increased in AVS. In immunohistochemical stainings, the expressions of cathepsin S, cathepsin V, and cystatin C localized to valvular macrophages, chondroblast-like cells, and endothelial cells lining both the valvular surface and the neovessels in the stenotic valves. Next, we characterized the neovessels and lymphatic vessels in stenotic aortic valves and control valves using immunohistochemistry. We found that in addition to immature microvessels, the stenotic aortic valves contained organized arterioles, indicating an advanced stage of angiogenesis. Lymphatic vessels correlated with valvular blood vessels, but were present in much fewer numbers. Valvular mast cells resided close to neovessels and secreted the angiogenic Vascular endothelial growth factor A (VEGF-A). Furthermore, we showed that the lymphangiogenic growth factors VEGF-C and VEGF-D are locally produced in the aortic valves, and that the receptors for all these VEGFs, VEGFR-2 and VEGFR-3, are upregulated in AVS. We also identified several factors that induce VEGF-A secretion in cultured valvular myofibroblasts. These include mast cell-derived components, the inflammatory cytokine TNF-α, hypoxia, and cigarette smoke. Myofibroblasts were also able to promote VEGF-A secretion by cultured human mast cells, suggesting potential angiogenic interplay between these two valvular cell types. Interestingly, mast cell-derived proteases also efficiently degraded the lymphangiogenic growth factor VEGF-C. Thus, by secreting VEGF-A, by urging myofibroblasts to produce VEGF-A, and by releasing VEGF-C-degrading proteases, mast cells may strongly influence the observed imbalance between valvular blood vessels and lymphatic vessels. Finally, we investigated the potential effects of oxidized low-density lipoprotein (oxLDL) on valvular angiogenesis. We found that oxLDL induces the expression of several inflammatory cytokines in cultured myofibroblasts. Moreover, we identified oxLDL-binding scavenger receptors to be locally expressed in the aortic valves. The mRNA expression levels of scavenger receptor class A type 1 (SR-A1) and Lectin-like oxidized LDL receptor-1 (LOX-1) were increased in AVS, whereas CD36 was downregulated in stenotic valves. Furthermore, the expression of LOX-1 in cultured valvular myofibroblasts increased in response to mast cell-derived components and TNF-α. The observed changes in valvular scavenger receptor expression particularly favor inflammation and angiogenesis. In conclusion, several angiogenic factors were found to be activated in stenotic aortic valves. Furthermore, valvular mast cells and myofibroblasts were identified as potential players promoting valvular angiogenesis and contributing to the pathological imbalance between valvular angiogenesis and lymphangiogenesis. This imbalance, in turn, could facilitate the harmful infiltration of inflammatory cells and lipoproteins into the stenotic aortic valves and ultimately contribute to the progression of the disease.
  • Siikala, Emilia (Helsingin yliopisto, 2011)
    Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS1) is an autoimmune disease caused by a loss-of function mutation in the autoregulator gene (AIRE). Patients with APECED suffer from chronic mucocutaneous candidosis (CMC) of the oral cavity and oesophagus often since early childhood. The patients are mainly colonized with Candida albicans and decades of exposure to antifungal agents have lead to the development of clinical and microbiological resistance in the treatment of CMC in the APECED patient population in Finland. A high incidence of oral squamous cell carcinoma is associated with oral CMC lesions in the APECED patients over the age of 25. The overall aim of this study was firstly, to investigate the effect of long-term azole exposure on the metabolism of oral C. albicans isolates from APECED patients with CMC and secondly, to analyse the specific molecular mechanisms that are responsible for these changes. The aim of the first study was to examine C. albicans strains from APECED patients and the level of cross-resistance to miconazole, the recommended topical compound for the treatment of oral candidosis. A total of 16% of the strains had decreased susceptibility to miconazole and all of these isolates had decreased susceptibility to fluconazole. Miconazole MICs also correlated with MICs to voriconazole and posaconazole. A significant positive correlation between the years of miconazole exposure and the MICs to azole antifungal agents was also found. These included azoles the patients had not been exposed to. The aim of our second study was to determine if the APECED patients are continuously colonized with the same C. albicans strains despite extensive antifungal treatment and to gain a deeper insight into the genetic changes leading to azole resistance. The strains were typed using MLST and our results confirmed that all patients were persistently colonized with the same or a genetically related strain despite antifungal treatment between isolations. No epidemic strains were found. mRNA expression was analysed by Northern blotting, protein level by western blotting, and TAC1 and ERG11 genes were sequenced. The main molecular mechanisms resulting in azole resistance were gain-of-function mutations in TAC1 leading to over expression of CDR1 and CDR2, genes linked to azole resistance. Several strains had also developed point mutations in ERG11, another gene linked to azole resistance. In the third study we used gas chromatography to test whether the level of carcinogenic acetaldehyde produced by C. albicans strains isolated from APECED patients were different from the levels produced by strains isolated from healthy controls and oral carcinoma patients. Acetaldehyde is a carcinogenic product of alcohol fermentation and metabolism in microbes associated with cancers of the upper digestive tract. In yeast, acetaldehyde is a by-product of the pyruvate bypass that converts pyruvate into acetyl-CoA during fermentation. Our results showed that strains isolated from APECED patients produced mutagenic levels of acetaldehyde in the presence of glucose (100mM, 18g/l) and the levels produced were significantly higher than those from strains isolated from controls and oral carcinoma patients. All strains in the study, however, were found to produce mutagenic levels of acetaldehyde in the presence of ethanol (11mM). The glucose and ethanol levels used in this study are equivalent to those found in food and beverages and our results highlight the role of dietary sugars and ethanol on carcinogenesis. The aims of our fourth study were to research the effect of growth conditions in the levels of acetaldehyde produced by C. albicans and to gain deeper insight into the role of different genes in the pyruvate-bypass in the production of high acetaldehyde levels. Acetaldehyde production in the presence of glucose increased by 17-fold under moderately hypoxic conditions compared to the levels produced under normoxic conditions. Under moderately hypoxic conditions acetaldehyde levels did not correlate with the expression of ADH1 and ADH2, genes catalyzing the oxidation of ethanol to acetaldehyde, or PDC11, the gene catalyzing the oxidation of pyruvate to acetaldehyde but correlated with the expression of down-stream genes ALD6 and ACS1. Our results highlight a problem where indiscriminate use of azoles may influence azole susceptibility and lead to the development of cross-resistance. Despite clinically successful treatment leading to relief of symptoms, colonization by C. albicans strains is persistent within APECED patients. Microevolution and point mutations that occur in strains may lead to the development of azole-resistant isolates and metabolic changes leading to increased production of carcinogenic acetaldehyde.
  • Helmy, Mohamed (Helsingin yliopisto, 2014)
    Birth asphyxia is a major cause of infant and childhood death, disability and neurodevelopmental delay worldwide. During birth, impairment of respiration is reflected in elevated levels of CO2 and diminished levels of O2 in the neonate. The fundamental presentation and diagnostic criterion of birth asphyxia is severe acidosis, most commonly measured in umbilical blood. Resuscitation is associated with normalization of blood pH values and arterial blood gases. Within hours of a moderate or severe asphyxic insult during birth, severe seizures are triggered. In the present study, asphyxic conditions during birth are modeled as an induced hypoxia and hypercapnia in postnatal day 6 rat pups. Respiratory conditions are altered so that pups breathe 20 % CO2 with either 9 % O2 or 4 % O2 (N2 balanced) for 60 or 45 minutes, respectively. Brain extracellular and intraneuronal pH became rapidly acidotic during asphyxic conditions. After experimental asphyxia, immediate restoration of normoxia and normocapnia was associated with a large seizure burden. Seizures in the postasphyxia period were tightly correlated with a recovery and alkaline overshoot in brain pH. Enhanced acid extrusion from the brain was attributed to increased Na/H exchange across the blood-brain barrier. Pharmacologic blockade of Na/H exchange in the blood-brain barrier with amiloride or its analog abolished brain alkalosis and seizures. These findings suggest that a brain-confined alkalosis is generated by Na/H exchangers in the blood-brain barrier when normocapnic conditions are immediately restored after experimental birth asphyxia. A putative therapeutic strategy was tested, where the CO2 level of inhaled air in the postasphyxic period was reduced in steps, so that normocapnic conditions are gradually restored. This graded restoration of normocapnia was achieved by exposing the pup to 10 % CO2 in air for 30 minutes, followed by 5 % CO2 in air for a further 30 minutes, and finally with room air. A dramatic attenuation of brain alkalosis and seizures was induced by graded restoration of normocapnia. Immediate restoration of normocapnia after asphyxia was associated with adverse outcome in juvenile and adult rats, manifest as compromised sensorimotor coordination, altered emotional reactivity to acute stress, diminished inhibition of fear-motivated behavior, impaired memory and learning, abnormal social interaction, and increased seizure susceptibility. Graded restoration of normocapnia after asphyxia was associated with significant and favorable improvement of outcome, such that behavioral deficits were rescued, and seizure threshold was not significantly different from control animals. The findings of the this study suggest a central role for Na/H exchange in the blood-brain barrier in mediating the postasphyxia brain alkalosis as measured in the present study as well as in human babies. Importantly, the findings also suggest a putative therapeutic strategy in which recovery from acidosis during neonatal resuscitation is controlled through a graded restoration of normocapnia.
  • Ludwig, Anastasia (Helsingin yliopisto, 2008)
    Gamma-aminobutyric acid (GABA) acting through ionotropic GABAA receptors plays a crucial role in the activity of the central nervous system (CNS). It triggers Ca2+ rise providing trophic support in developing neurons and conducts fast inhibitory function in mature neuronal networks. There is a developmental change in the GABAA reversal potential towards more negative levels during the first two postnatal weeks in rodent hippocampus. This change provides the basis for mature GABAergic activity and is attributable to the developmental expression of the neuron-specific potassium chloride cotransporter 2 (KCC2). In this work we have studied the mechanisms responsible for the control of KCC2 developmental expression. As a model system we used hippocampal dissociated cultures plated from embryonic day (E) 17 mice embryos before the onset of KCC2 expression. We showed that KCC2 was significantly up-regulated during the first two weeks of culture development. Interestingly, the level of KCC2 upregulation was not altered by chronic pharmacological blockage of action potentials as well as GABAergic and glutamatergic synaptic transmission. By in silico analysis of the proximal KCC2 promoter region we identified 10 candidate transcription factor binding sites that are highly conserved in mammalian KCC2 genes. One of these transcription factors, namely early growth response factor 4 (Egr4), had similar developmental profile as KCC2 and considerably increased the activity of mouse KCC2 gene in neuronal cells. Next we investigated the involvement of neurotrophic factors in regulation of Egr4 and KCC2 expression. We found that in immature hippocampal cultures Egr4 and KCC2 levels were strongly up-regulated by brain derived neurotrophic factor (BDNF)and neurturin. The effect of neurotrophic factors was dependent on the activation of a mitogen activated protein kinase (MAPK) signal transduction pathway. Intact Egr4-binding site in proximal KCC2 promoter was required for BDNF-induced KCC2 transcription. In vitro data were confirmed by several in vivo experiments where we detected an upregulation of KCC2 protein levels after intrahippocampal administration of BDNF or neurturin. Importantly, a MAPK-dependent rise in Egr4 and KCC2 expression levels was also observed after a period of kainic acid-induced seizure activity in neonatal rats suggesting that neuronal activity might be involved in Egr4-mediated regulation of KCC2 expression. Finally we demonstrated that the mammalian KCC2 gene (alias Slc12a5) generated two neuron-specific isoforms by using alternative promoters and first exons. A novel isoform of KCC2, termed KCC2a, differed from the previously known KCC2b isoform by 40 unique N-terminal amino acid residues. KCC2a expression was restricted to CNS,remained relatively constant during postnatal development, and contributed 20 50% of total KCC2 mRNA expression in the neonatal mouse brainstem and spinal cord. In summary, our data provide insight into the complex regulation of KCC2 expression during early postnatal development. Although basal KCC2 expression seems to be intrinsically regulated, it can be further augmented by neurotrophic factors or by enhanced activity triggering MAPK phosphorylation and Egr4 induction. Additional KCC2a isoform, regulated by another promoter, provides basal KCC2 level in neonatal brainstem and spinal cord required for survival of KCC2b knockout mice.
  • Kangas, Nuutti (Helsingin yliopisto, 2000)
  • Lehto, Paula (Helsingin yliopisto, 2010)
    Drug absorption after oral administration requires that the drug first dissolves into gastro-intestinal tract liquids. In vivo dissolution of a drug is affected by physiological and drug-related physicochemical factors. In the case of poorly water-soluble drugs, in vitro dissolution testing at various stages of drug development is especially important, since the absorption is predominantly limited by the dissolution rate. Varying dissolution rates, possible for different physical structures of the same chemical entity (known as polymorphs), for example, can lead to varying degrees of bioavailability and, potentially, result in therapeutic failure. Traditionally, pharmaceutical dissolution testing has relied on determination of the dissolved drug concentration from liquid phase. This has led to poor understanding (and possible underestimation) of the connection between the change in solid phase and dissolution behaviour. Thus, new powerful approaches are needed. To correlate in vitro dissolution results of drug products with in vivo behaviour often requires the use of dissolution methods reflecting conditions in the gastro-intestinal tract. For such purpose, various physiologically based dissolution media have been proposed. In this thesis, solid phase analysis was combined with dissolution determinations to provide in depth understanding of the effects of solid state properties on the intrinsic dissolution rate of active pharmaceutical ingredients (API). A new approach to dissolution testing, which involved simultaneous in situ solid phase analyses of the dissolving sample and measurement of dissolved concentrations in the dissolution medium, were utilized to explain the implications of solvent-mediated solid phase conversions on dissolution processes. Simplified dissolution media were developed and studied for the prediction of in vivo behaviour of Biopharmaceutics Classification System (BCS) class II drugs. Quantitative solid phase analysis using Raman spectroscopy was successfully performed in situ during the intrinsic dissolution testing of APIs. Direct solid phase analysis in tandem with measurement of dissolved concentrations enabled molecular level insight into changes in dissolution rate due to hydrate formation. Against expectations, preferred orientation of drug crystals during sample preparation was shown to have only minor effects on dissolution results during intrinsic dissolution. Importance of dissolution medium on solvent-mediated conversion kinetics was revealed as bile salts were shown to be able to interact with the dissolving solid by hydrogen bonding mechanisms. To predict in vivo behaviour of BCS class II drugs, simple and cost-effective conventional surfactant media were shown to be potential substitutes for more complex, physiologically based Fasted State Simulated Intestinal Fluid (FaSSIF). This thesis provides directly applicable new tools for the dissolution experiments in pharmaceutical drug development. In-depth information of solid state properties on dissolution rate assists in drug candidate selection as well as in explaining and controlling the behaviour of APIs in the final drug products. The use of simplified, in vivo prognostic dissolution media has potential of saving development time and costs for formulation development and regulatory purposes.
  • Vesterinen, Olli (Helsingin yliopisto, 2011)
    The aim of the doctoral dissertation was to further our theoretical and empirical understanding of media education as practised in the context of Finnish basic education. The current era of intensive use of the Internet is recognised too. The doctoral dissertation presents the subject didactic dimension of media education as one of the main results of the conceptual analysis. The theoretical foundation is based on the idea of dividing the concept of media education into media and education (Vesterinen et al., 2006). As two ends of the dimension, these two can be understood didactically as content and pedagogy respectively. In the middle, subject didactics is considered to have one form closer to content matter (Subject Didactics I learning about media) and another closer to general pedagogical questions (Subject Didactics II learning with/through media). The empirical case studies of the dissertation are reported with foci on media literacy in the era of Web 2.0 (Kynäslahti et al., 2008), teacher reasoning in media educational situations (Vesterinen, Kynäslahti - Tella, 2010) and the research methodological implications of the use of information and communication technologies in the school (Vesterinen, Toom - Patrikainen, 2010). As a conclusion, Media-Based Media Education and Cross-Curricular Media Education are presented as two subject didactic modes of media education in the school context. Episodic Media Education is discussed as the third mode of media education where less organised teaching, studying and learning related to media takes place, and situations (i.e. episodes, if you like) without proper planning or thorough reflection are in focus. Based on the theoretical and empirical understanding gained in this dissertation, it is proposed that instead of occupying a corner of its own in the school curriculum, media education should lead the wider change in Finnish schools.
  • Salovaara-Moring, Inka (Helsingin yliopisto, 2004)
  • Eklund, Anne (Helsingin yliopisto, 2006)
    Mediastinitis as a complication after cardiac surgery is rare but disastrous increasing the hospital stay, hospital costs, morbidity and mortality. It occurs in 1-3 % of patients after median sternotomy. The purpose of this study was to find out the risk factors and also to investigate new ways to prevent mediastinitis. First, we assessed operating room air contamination monitoring by comparing the bacteriological technique with continuous particle counting in low level contamination achieved by ultra clean garment options in 66 coronary artery bypass grafting operations. Second, we examined surgical glove perforations and the changes in bacterial flora of surgeons' fingertips in 116 open-heart operations. Third, the effect of gentamicin-collagen sponge on preventing surgical site infections (SSI) was studied in randomized controlled study with 557 participants. Finally, incidence, outcome, and risk factors of mediastinitis were studied in over 10,000 patients. With the alternative garment and textile system (cotton group and clean air suit group), the air counts fell from 25 to 7 colony-forming units/m3 (P<0.01). The contamination of the sternal wound was reduced by 46% and that of the leg wound by >90%. In only 17% operations both gloves were found unpunctured. Frequency of glove perforations and bacteria counts of hands were found to increase with operation time. With local gentamicin prophylaxis slightly less SSIs (4.0 vs. 5.9%) and mediastinitis (1.1 vs. 1.9%) occurred. We identified 120/10713 cases of postoperative mediastinitis (1.1%). During the study period, the patient population grew significantly older, the proportion of women and patients with ASA score >3 increased significantly. In multivariate logistic regression analysis, the only significant predictor for mediastinitis was obesity. Continuous particle monitoring is a good intraoperative method to control the air contamination related to the theatre staff behavior during individual operation. When a glove puncture is detected, both gloves are to be changed. Before donning a new pair of gloves, the renewed disinfection of hands will help to keep their bacterial counts lower even towards the end of long operation. Gentamicin-collagen sponge may have beneficial effects on the prevention of SSI, but further research is needed. Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures.
  • Ahonen, Laura (Helsingin yliopisto, 2007)
    The subject of the thesis is the mediated construction of author images in popular music. In the study, the construction of images is treated as a process in which artists, the media and the members of the audience participate. The notions of presented, mediated and compiled author images are used in explaining the mediation process and the various authorial roles of the agents involved. In order to explore the issue more closely, I analyse the author images of a group of popular music artists representing the genres of rock, pop and electronic dance music. The analysed material consists mostly of written media texts through which the artists authorial roles and creative responsibilities are discussed. Theoretically speaking, the starting points for the examination lie in cultural studies and discourse analysis. Even though author images may be conceived as intertextual constructions, the artist is usually presented as a recognizable figure whose purpose is to give the music its public face. This study does not, then, deal with musical authors as such, but rather with their public images and mediated constructions. Because of the author-based functioning of popular music culture and the idea of the artist s individual creative power, the collective and social processes involved in the making of popular music are often superseded by the belief in a single, originating authorship. In addition to the collective practices of music making, the roles of the media and the marketing machinery complicate attempts to clarify the sharing of authorial contributions. As the case studies demonstrate, the differences between the examined author images are connected with a number of themes ranging from issues of auteurism and stardom to the use of masked imagery and the blending of authorial voices. Also the emergence of new music technologies has affected not only the ways in which music is made, but also how the artist s authorial status and artistic identity is understood. In the study at hand, the author images of auteurs, stars, DJs and sampling artists are discussed alongside such varied topics as collective authorship, evaluative hierarchies, visual promotion and generic conventions. Taken altogether, the examined case studies shed light on the functioning of popular music culture and the ways in which musical authorship is (re)defined.
  • Alaranta, Antti (Helsingin yliopisto, 2006)
    For many athletes, sport is not safe enough without medicines. Heavy physical training causes several physiological and pathophysiological changes and stress in respiratory, cardiovascular, immunologic, endocrinological, and musculoskeletal systems in highly-trained athletes. If athletes suffer from asthma, high blood pressure, or cardiac arrhythmia, sport challenges their bodies under unique stresses, which raise the likelihood of a chronic or catastrophic harm. The present study aimed at determining the use of prescribed medication and factors associated with it in a large number of elite athletes compared with a representative control sample of the general population. Of all the athletes (N = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3%) in 2002. A control group (N = 1503, response rate 80.1%) comprised an age-matched sample from the population-based study collected by the National Public Health Institute. The use of prescribed asthma and allergy medication, non-steroidal anti-inflammatory drugs (NSAID), and oral antibiotics during the past seven days is 2-4-fold in elite athletes compared with the general population of the same age. Allergy medication is most commonly used medicine group among athletes followed by NSAIDs, asthma medication and oral antibiotics. Every fifth athlete reported of the adverse effects associated with the use of NSAIDs. The frequency of self-reported asthma medication is clearly lower than the reported occurrence of physician-diagnosed asthma in a large sample of Finnish Olympic athletes. Use of asthma medication is most frequent in endurance athletes, but no difference is found between winter and summer sport athletes. Female athletes use asthma medication more often than males. No evidence of overuse of inhaled 2-agonists is found. Treatment of airway inflammation seems unsatisfactory. Endurance athletes have physician-diagnosed allergic rhinitis and they use allergy medication more often than athletes in other events or control subjects. Female athletes use allergy medication more frequently than male athletes. Only half of the athletes reporting allergic rhinitis take allergy medication. More attention needs to be paid to the optimal management of allergic rhinitis in highly-trained athletes. All the above-mentioned medicines have potential adverse effects that may have deleterious impact on the maximum exercise performance of elite athletes. Thus, any unnecessary medicine use should be minimized in elite athletes.
  • Pohjanoksa-Mäntylä, Marika (Helsingin yliopisto, 2010)
    The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.
  • Mäkinen, Netta (Helsingin yliopisto, 2015)
    Uterine leiomyomas, or fibroids, are benign tumors arising from the smooth muscle lining of the uterus, the myometrium. Although they represent one of the most common neoplasms in women with an estimated prevalence of 20-40% during the reproductive years, the molecular mechanisms underlying their tumorigenesis have remained relatively unknown. The aim of this thesis was to elucidate the molecular genetic characteristics of uterine leiomyomas using next-generation sequencing technology. Exome sequencing of 18 uterine leiomyomas and the respective normal myometrium from 17 Finnish (Caucasian) patients led to the identification of recurrent somatic mutations in mediator complex subunit 12 (MED12) gene. This, and further Sanger sequencing of 207 additional leiomyomas revealed that a remarkable 70% (159/225) of the tumors harbor MED12 mutations. MED12 is a component of the Mediator complex, which participates in the regulation of global as well as gene-specific transcription. All the observed mutations resided in exon 2 or the intron 1-exon 2 junction, an evolutionarily conserved region of the gene, suggesting that malfunction of the region contributes to tumorigenesis. This was the first time MED12 mutations have been implicated in human tumorigenesis. To validate the finding and determine the frequency of MED12 exon 2 mutations in another ethnic group, a series of 28 uterine leiomyomas from 18 South African patients underwent Sanger sequencing for the mutations. Altogether 50% (14/28) of the tumors displayed a mutation, indicating that MED12 mutations occur frequently also in uterine leiomyomas of South African women. Overall, the result confirms the role of these mutations in the growth and development of leiomyomas regardless of ethnicity. Original identification of MED12 exon 2 mutations took place in a series of histopathologically conventional uterine leiomyomas which account for approximately 90% of the tumors. To assess the frequency of MED12 mutations in rarer clinical leiomyoma subtypes, 103 histopathological uterine leiomyoma variants, as well as 34 uterine leiomyomas from 14 patients with hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome, a disease caused by heterozygous germline mutations in fumarate hydratase (FH) gene, entered the study. Both the histopathological leiomyoma variants (17%; 18/103) and leiomyomas from HLRCC-patients (9%; 3/34) harbored MED12 mutations significantly less frequently than conventional leiomyomas (P less than 0.001), proposing that MED12 mutation positivity is a key characteristic of conventional leiomyomas. Of note, none of the MED12 mutation-positive tumors from HLRCC-patients displayed biallelic FH inactivation, a well-known attribute of tumors in HLRCC, suggesting that MED12 mutations and biallelic FH inactivation may be mutually exclusive. Exome sequencing of 27 uterine leiomyomas (12 MED12 mutation-negative and 15 MED12 mutation-positive) and their corresponding normal myometrium revealed no additional recurrent somatic mutations in either MED12 mutation-negative or -positive tumors. The result emphasizes the significance of MED12 mutations for the tumorigenesis of uterine leiomyomas. Alterations undetectable by exome sequencing, such as structural rearrangements, intronic variants, and epigenetic events, probably have an impact to the development of MED12 mutation-negative lesions. The discovery of MED12 mutations is a giant step forward in understanding the pathogenesis of uterine leiomyomas, hopefully leading to improved diagnosis, personalized medical treatments, and prognosis in the future.
  • Arho Havrén, Sari (Helsingin yliopisto, 2009)
    "We have neither Eternal Friends nor Eternal Enemies. We have only Eternal Interests .Finland's Relations with China 1949-1989 The study focuses on the relations between Finland and the People s Republic of China from 1949-1989 and examines how a small country became embroiled in international politics, and how, at the same time, international politics affected Finnish-Chinese relations and Finland s China policy formulation. The study can be divided into three sections: relations during the early years, 1949-1960, before the Chinese and Soviet rift became public; the relations during the passive period during the 1960s and 1970s; and the impact of China s Open Door policy on Finland s China policy from 1978-1989. The diplomatically challenging events around Tiananmen Square and the reactions which followed in Finland bring the study to a close. Finland was among the first Western countries to recognise the People s Republic and to establish diplomatic relations with her, thereby giving Finland an excellent position from which to further develop good relations. Finland was also the first Western country to sign a trade agreement with China. These two factors meant that Finland was able to enjoy a special status with China during the 1950s. The special status was further strengthened by the systematic support of the government of Finland for China's UN membership. The solid reputation earned in the 1950s had to carry Finland all the way through to the 1980s. For the two decades in between, during the passive policy period of the 1960s and 1970s, relations between Finland and the Soviet Union also determined the state of foreign relations with China. Interestingly, however, it appeared that President Urho Kekkonen was encouraged by Ambassador Joel Toivola to envisage a more proactive policy towards China, but the Cultural Revolution cut short any such plan for nearly twenty years. Because of the Soviet Union, Finland held on to her passive China policy, even though no such message was ever received from the Soviet Union. In fact, closer relationships between Finland and China were encouraged through diplomatic channels. It was not until the presidency of Mauno Koivisto that the first high-level ministerial visit was made to China when, in 1984, Foreign Minister Paavo Väyrynen visited the People s Republic. Finnish-Chinese relations were lifted to a new level. Foreign Minister Väyrynen, however, was forced to remove the prejudices of the Chinese. In 1985, when the Speaker of the Finnish Parliament, Erkki Pystynen visited China he also discovered that Finland s passive China policy had caused misunderstandings amongst the Chinese politicians. The number of exchanges escalated in the wake of the ground-breaking visit by Foreign Minister Väyrynen: Prime Minister Kalevi Sorsa visited China in 1986 and President Koivisto did so in 1988. President Koivisto stuck to practical, China-friendly policies: his correspondence with Li Peng, the attitude taken by the Finnish government after the Tiananmen Square events and the subsequent choices made by his administration all pointed to a new era in relations with China.