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Background: Only a few studies reporting the long-term outcome of children with idiopathic tubulointerstitial nephritis (TIN) and uveitis syndrome (TINU) are available. We studied the long-term kidney and ocular outcome in a nationwide cohort of children with TIN or TINU. Methods: All patients followed up for a minimum of 1 year by a paediatrician and an ophthalmologist were enrolled. The data on plasma creatinine (P-Cr), estimated glomerular filtration rate (eGFR), proteinuria, hypertension and uveitis were collected retrospectively. Results: Fifty-two patients were studied. Median age at time of diagnosis was 13.1 (1.8–16.9) years and median follow-up time was 5.7 (1.1–21.2) years. Forty-five (87%) patients were initially treated with glucocorticoids. The median of the maximum P-Cr was 162 μmol/l (47–1,016) and that of eGFR 47 ml/min/1.73m2 (8–124). Uveitis was diagnosed in 33 patients (63%) and 21 (40%) patients developed chronic uveitis. P-Cr normalised in a median of 2 months. Eleven (21%) patients had nephritis recurrence during or after discontinuation of glucocorticoids. At the latest follow-up, 13 (25%) patients had eGFR < 90 ml/min/1.73m2 (median 83; 61–89 ml/min/1.73m2). Six patients had tubular proteinuria; all presented with TIN without uveitis. Seven (13%) patients were hypertensive. Eleven (21%) patients had uveitis. One patient developed uraemia and was later transplanted. Conclusions: Our study questions the previously reported good long-term kidney and ocular outcome of patients with TIN/TINU. Decreased kidney function and/or ocular co-morbidities may persist for several years; thus, both kidney and ocular follow-up for at least 1 year is warranted. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information[Figure not available: see fulltext.]
Tutkimuksessa paneudutaan Suomen perustuslain ja tämänhetkisen poikkeuslakina voimassa olevan valmiuslain suhteeseen. Sen yhtenä tarkoituksena on tarkastella niitä seikkoja, joihin olisi puututtava mahdollisessa tulevassa lainsäädäntötyössä, jotta valmiuslain poikkeuslakipohjaisuus saataisiin samalla muutettua. Tutkimuksessa tuodaan esiin, kuinka keskeisesti Suomen perustuslain perusoikeuksia poikkeusoloissa koskeva sääntely on kansainvälisiin ihmisoikeussopimuksiin sidottua. Lisäksi esitetään vertailuja vastaavista muista eurooppalaisista sääntelymalleista. Erityisesti ensiksi mainitulla seikalla on myös aineellista merkitystä sen osalta, minkä sisältöiseksi valmiuslakia voidaan muuttaa ylipäätään. Valmiuslain voimassaollessa perustuslakia on muutettu niin, että valmiuslain tapaisessa sääntelyssä olisi helpommin täytettävissä perustuslain asettamat vaatimukset. Silti perustuslaki asettaa täysin perustellusti korkeat vaatimukset esimerkiksi sille, millaisissa poikkeusoloissa ja millä tavoin lainsäädäntövallan delegointia soveltaen perusoikeuksista voidaan poiketa. Näistä vaatimuksista on pidettävä kiinni, ja näin ollen valmiuslakia muutettaessa tulee kiinnittää huomiota perustuslain asettamiin sisällöllisiin vaatimuksiin. Tutkimuksessa tuodaan esille, minkälaisia sisällöllisiä muutoksia perustuslaki ja sen taustalla oleva kansainvälinen normisto edellyttävät valmiuslakiin. Nämä muutostarpeet koskevat poikkeusolomääritelmää, ennen kaikkea niin sanotun puhtaan taloudellisen kriisin osalta, sekä miltei kauttaaltaan laissa olevia delegointeja. Näiden kahden suuremman muutosehdotuksen ohella tutkimus osoittaa myös eräitä muita muutostarpeita. Lisäksi ottaen huomioon delegointia koskevat muutostarpeet, tutkimus tuo myös esille vaihtoehtoisen näkökulman siitä, kuinka delegointia ja niiden laajuutta koskevat ongelmat voitaisiin mahdollisesti ratkaista erilaisella sääntelymallilla.
Sekä maatilojen että puutarhojen riippuvuus ostoenergiasta on lisääntynyt viime vuosikymmeninä systemaattisesti. Vastaava kehitys näyttää jatkuvan yksikkökokojen kasvun sekä digitalisaation ja automaation nopean kehittymisen seurauksena. Tämä tarkoittaa sähköenergian merkityksen korostumista entisestään. Maatilojen ja puutarhojen kyky vastata 2020-luvun sähkömarkkinoiden muuttuviin haasteisiin toiminnallisesti ja taloudellisesti järkevillä tavoilla perustuu siihen, että tilatasolla tunnettava sähkön kokonaiskulutuksen lisäksi yksittäisten laitteiden ja koneiden käytöstä syntyvä sähkökuorma ja sen vaihtelut vähintäänkin voimassa olevan sähkösopimuksen mukaisen energiankulutuksen mittaustavan tarkkuudella. Tämä mahdollistaa maatiloille ja puutarhoille sähkömarkkinoiden kulutus- ja tuotantojoustojen suunnitelmallisen hyödyntämisen sekä oman hajautetun sähköntuotannon ja -varastoinnin mitoittamisen optimoinnin. Energiantuotannon ja -käytön tulevaisuus maatiloilla hankkeen tutkimus-aineisto kerättiin kolmelta kotieläintilalta sekä yhdeltä opetusmaatilalta. Lisäksi yksittäisten tuottoprosessien ja niiden vaiheiden osalta tehtiin mittaussarjoja kontrolloiduissa testausympäristöissä. Hankkeen toteutusaikana tunnistettiin energiajärjestelmä toimintatapojen muuttuessa tarve riippumattomalla ja kumuloituvalle tiedolle hajautetusta energiantuotannosta, -varastoinnista ja -kulutuksesta energiatehokkuuden ja -omavaraisuuden parantamiseksi hyödyntäen AgriHubin viestinnällisiä palveluita.
Soils play multiple roles in vital ecosystem processes, even though they form only a thin layer between Earth’s atmosphere and lithosphere. Soils are reservoirs of carbon, most nutrients and fresh water while acting as a substrate for plants, a site for decomposition processes, and a sink for harmful substances. The decomposition of dead organic matter and the associated recycling of nutrients are a prerequisite for photosynthesis by green plants and, therefore, for all life forms on Earth. Without healthy soils, the integrity of the Earth system cannot be maintained in the future. Soils are highly diverse habitats, inhabited by both structurally and functionally diversified organisms. However, human activity is currently threatening both soil health and biodiversity. Intensive farming, mining, deforestation, pollution, and urbanization are significantly reducing the area of undisturbed land and simplifying the soil structure. This also represents a threat to nature’s contributions to people. On the road to planetary well-being, humanity should therefore pay particular attention to soils. This chapter discusses how soil processes contribute to the well-being of our planet and how the impacts of human activities on soil affect planetary well-being.
Background: Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)–producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome. Methods: The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis. Results: Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 × 109/L, and need for dialysis were predictive factors for poor renal outcome. Conclusions: Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms.
Abstract Background: Only a few studies reporting the long-term outcome of children with idiopathic tubulointerstitial nephritis (TIN) and uveitis syndrome (TINU) are available. We studied the long-term kidney and ocular outcome in a nationwide cohort of children with TIN or TINU. Methods: All patients followed up for a minimum of 1 year by a paediatrician and an ophthalmologist were enrolled. The data on plasma creatinine (P-Cr), estimated glomerular filtration rate (eGFR), proteinuria, hypertension and uveitis were collected retrospectively. Results: Fifty-two patients were studied. Median age at time of diagnosis was 13.1 (1.8–16.9) years and median follow-up time was 5.7 (1.1–21.2) years. Forty-five (87%) patients were initially treated with glucocorticoids. The median of the maximum P-Cr was 162 μmol/l (47–1,016) and that of eGFR 47 ml/min/1.73m2 (8–124). Uveitis was diagnosed in 33 patients (63%) and 21 (40%) patients developed chronic uveitis. P-Cr normalised in a median of 2 months. Eleven (21%) patients had nephritis recurrence during or after discontinuation of glucocorticoids. At the latest follow-up, 13 (25%) patients had eGFR < 90 ml/min/1.73m2 (median 83; 61–89 ml/min/1.73m2). Six patients had tubular proteinuria; all presented with TIN without uveitis. Seven (13%) patients were hypertensive. Eleven (21%) patients had uveitis. One patient developed uraemia and was later transplanted. Conclusions: Our study questions the previously reported good long-term kidney and ocular outcome of patients with TIN/TINU. Decreased kidney function and/or ocular co-morbidities may persist for several years; thus, both kidney and ocular follow-up for at least 1 year is warranted.
Abstract Background: Tubulointerstitial nephritis (TIN) is an inflammatory disease of unknown pathogenesis. To evaluate a possible role of regulatory T cells (Tregs) in the pathophysiology of TIN with (TINU) and without uveitis, we investigated the presence and quantity of FOXP3+ T regulatory lymphocytes in diagnostic kidney biopsies from pediatric patients. Methods: A total of 33 patients (14 TIN and 19 TINU) were enrolled. The quantity of CD4+, FOXP3+ and double-positive T cells in formalin-fixed kidney biopsies was determined using double label immunohistochemistry with anti-human CD4 and FOXP3 antibodies. Results: FOXP3 staining was successful in all 33 patients. In patients with chronic uveitis, the density of FOXP3+ cells was significantly lower (p = 0.046) than in TIN patients without uveitis or with uveitis lasting <3 months. CD4+ staining was successful in 23 patients. The density of all lymphocytes (CD4+, CD4+FOXP3+ and FOXP3+ cells) was significantly lower (p = 0.023) in patients with chronic uveitis than in other patients. Conclusions: FOXP3+ T cells are present in kidney biopsy samples from TIN and TINU patients. In patients with chronic uveitis, the density of FOXP3+ T cells is significantly lower than in other patients, suggesting a different pathomechanism for these clinical conditions.
Abstract Background: Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)–producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome. Methods: The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis. Results: Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 × 109/L, and need for dialysis were predictive factors for poor renal outcome. Conclusions: Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms.