14 research outputs found
Kauneudentemppelin ovella : Aino Kallaksen tuotanto ja raamatullinen subteksti
No full textAt the Gate of the Temple of Beauty. Aino Kallas' Oeuvre and the Biblical Subtext.
This study deals with the intertextual relationship between Aino Kallas oeuvre and the Bible. In this study, the Bible is understood as a general subtext of Kallas works. Aino Kallas (former Krohn, 1878-1956) was a Finnish-Estonian author, whose oeuvre nowadays is a part of the literary canons of both countries. Her role in the canon is, however, considered differently in Finland and in Estonia.
The notion of intertextuality has been redefined several times in the past decades. In this study, intertextuality is, mainly, understood as a practical tool for analysing texts (e.g. K. Taranovski, H. F. Plett, W. Müller).
In the previous body of research, the role of the Bible in Kallas oeuvre has been seen in a much smaller role than in this study. It has previously been suggested, that Kallas imitated a biblical style mainly in her historical stories of the 1920s. Primarily, imitation of the biblical style has been seen as a feature of her so-called archaic style. In this study, the biblical subtext is considered as one of the most significant features in Kallas works, opening up whole new interpretations of her stories. The most essential works in this study are Kallas novels, short stories and plays between the years of 1910 and 1937.
In 1904, Aino Kallas published her first work set in an Estonian milieu. Soon after that, she began to search for new forms of literary expression. This period is currently known as the literary crisis of Aino Kallas (between the years of 1908 and 1912).
In this study, it is argued that Kallas started to use the Bible as a general subtext in her works during the years of her literary crisis . The earliest and also the strongest indication of this is her biblical poetic play Bathseba (1910). For Aino Kallas, writing Bathseba was an ambitious project. However, at the time, the play was not considered to be of any merit and was not published. It was also believed to be totally lost, until the author of this study came across it in the archives of the Estonian Literary Museum (2008).
In the 1910s and 1920s, Aino Kallas published several short stories with strong intertextual connections to biblical myths. The best-known part of Kallas oeuvre is her historical stories of the 1920s and 1930s, which also are analysed in the present study. In the 1940s, Kallas published three works of poetry, in which she returned to the traces of her early Bathseba. She, for example, uses the biblical subtext in a way characteristic only of Bathseba: by imitating the style of the poetry of the Old Testament. Aino Kallas oeuvre has been studied largely in Finland and in Estonia. However, these previous studies have had a contextual and a bibliographical orientation towards the subject. This dissertation is the first text-orientated, intertextual study of Kallas works. It is also the first monograph which deals with the intertextual relationship between the Bible and the oeuvre of a Finnish female author.
Key words: Aino Kallas, intertextuality, biblical subtext, Finnish literature, Estonian literatureKauneudentemppelin ovella. Aino Kallaksen tuotanto ja raamatullinen subteksti. Akateeminen väitöskirja.
Tutkimus käsittelee suomalais-virolaisen kirjailijan Aino Kallaksen (o.s. Krohn, 1878-1956) kaunokirjallista tuotantoa. Pääkysymys on Kallaksen tuotannon suhde Raamattuun, jota tarkastellaan teosten subtekstinä. Tutkimuksen teoreettisen viitekehyksen luo intertekstuaalisuuden tutkimus, erityisesti intertekstuaalisuusajatuksen sovellukset käytännön tekstianalyysiin (mm. Taranovski, Plett, Juvan, Müller).
Aino Kallas on Suomen ja Viron yhteiskirjailija , jonka tuotanto kuuluu kummankin maan kirjallisuushistoriaan. Kirjailijan rooli kansallisen kirjallisuuden kaanonissa poikkeaa kuitenkin näissä kahdessa maassa jossain määrin toisistaan.
Kallas alkoi julkaista virolaisaiheisia teoksia vuonna 1904. Pian tämän jälkeen hän alkoi etsiä ilmaisulleen vahvasti uutta suuntaa. Tämä tunnetaan Kallaksen ns. kirjallisen kriisin aikana (n. vuodet 1908-1912).
Tutkimuksessani esitän, että Raamattu tuli Kallaksen tuotannon subtekstiksi kirjailijan kirjallisen kriisin vuosina. Varhaisin ja vahvin osoitus tästä on raamatullinen runonäytelmä Bathseba (1910). Näytelmää pidettiin epäonnistuneena, ja se jäi julkaisematta. Sen luultiin myös kadonneen, ennen kuin löysin sen Viron Kirjallisuusmuseosta tutkimustyöni yhteydessä (2008).
Raamattu on aiemmin nähty Kallaksen tuotannossa lähinnä tyylillisesti jäljiteltynä tekstinä, ennen kaikkea kirjailijan ns. arkaisoivan tyylin osatekijänä 1920-luvun tuotannossa. Tässä tutkimuksessa Raamattu ymmärretään Kallaksen tuotannon pitkäaikaiseksi ja keskeiseksi subtekstiksi, joka vaikuttaa mitä olennaisimmin teoksista tehtävään kokonaistulkintaan. Keskeisimmän tutkimusaineiston luovat kirjailijan 1910-1930-lukujen novellit, pienoisromaanit ja näytelmät.
Aino Kallaksen tuotantoa on tutkittu melko paljon sekä Suomessa että Virossa. Tähänastinen tutkimus on kuitenkin ollut taustalähtöisesti ja / tai biografisesti orientoitunutta. Väitöskirjani on ensimmäinen tekstilähtöinen tutkimus Aino Kallaksen tuotannosta. Se on myös ensimmäinen monografia, joka käsittelee suomalaisen naiskirjailijan ja Raamatun välistä intertekstuaalista suhdetta.
Avainsanat: Aino Kallas, vuosisadanvaihteen suomalainen kirjallisuus, virolainen kirjallisuus, subteksti, intertekstuaalisuus, Raamattu kaunokirjallisuudessaei saavutettav
Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort study
No full textBackground: Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12–24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear. Aims: We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO. Methods: This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0–3, and secondary outcomes comprised mRS 0–2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested. Results: Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0–3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31–4.12]), mRS 0–2 (aOR = 1.93 [95% CI = 1.12–3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21–2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29–0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28–2.36]). No interactions for the primary outcome were found. Conclusion: In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients. Data access statement: Anonymized data are available upon reasonable request to the corresponding author following the national legislation.Peer reviewe
Impact of trial attrition rates on treatment effect estimates in chronic inflammatory diseases:A meta-epidemiological study
Get PDFThe objective of this meta-epidemiological study was to explore the impact of attrition rates on treatment effect estimates in randomised trials of chronic inflammatory diseases (CID) treated with biological and targeted synthetic disease-modifying drugs. We sampled trials from Cochrane reviews. Attrition rates and primary endpoint results were retrieved from trial publications; Odds ratios (ORs) were calculated from the odds of withdrawing in the experimental intervention compared to the control comparison groups (i.e., differential attrition), as well as the odds of achieving a clinical response (i.e., the trial outcome). Trials were combined using random effects restricted maximum likelihood meta-regression models and associations between estimates of treatment effects and attrition rates were analysed. From 37 meta-analyses, 179 trials were included, and 163 were analysed (301 randomised comparisons; n = 62,220 patients). Overall, the odds of withdrawal were lower in the experimental compared to control groups (random effects summary OR = 0.45, 95% CI, 0.41–0.50). The corresponding overall treatment effects were large (random effects summary OR = 4.43, 95% CI 3.92–4.99) with considerable heterogeneity across interventions and clinical specialties (I2 = 85.7%). The ORs estimating treatment effect showed larger treatment benefits when the differential attrition was more prominent with more attrition in the control group (OR = 0.73, 95% CI 0.55–0.96). Higher attrition rates from the control arm are associated with larger estimated benefits of treatments with biological or targeted synthetic disease-modifying drugs in CID trials; differential attrition may affect estimates of treatment benefit in randomised trials.</p
Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort study
Get PDFFunding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by Helsinki University Hospital governmental subsidiary funds for clinical research (S.R., P.J.L., D.Strbian). Publisher Copyright: © 2025 World Stroke Organization.Background: Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12–24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear. Aims: We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO. Methods: This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0–3, and secondary outcomes comprised mRS 0–2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested. Results: Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0–3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31–4.12]), mRS 0–2 (aOR = 1.93 [95% CI = 1.12–3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21–2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29–0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28–2.36]). No interactions for the primary outcome were found. Conclusion: In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients. Data access statement: Anonymized data are available upon reasonable request to the corresponding author following the national legislation.publishersversioninpres
European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion.
No full textThe aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology.Although BAO accounts for only 1-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five representing the European Society of Minimally Invasive Neurological Therapy (ESMINT)) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements.First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (although in small numbers) in IVT trials. Non-randomized studies of IVT-only cohorts showed a high proportion of favorable outcomes. Expert Consensus suggests using IVT up to 24 hours unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared with BMT alone within 6 and 6-24 hours from last seen well. In both time windows, we observed a different effect of treatment depending on a) the region where the patients were treated (Europe vs Asia), b) on the proportion of IVT in the BMT arm, and c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with a National Institutes of Health Stroke Scale (NIHSS) score below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT+BMT over BMT alone (this is based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS score below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT+BMT over BMT alone in proximal and middle locations of BAO compared with distal location. While recommendations for patients without extensive early ischemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 hours after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty)
Longitudinal multi-omics analysis identifies early blood-based predictors of anti-TNF therapy response in inflammatory bowel disease.
Get PDFBACKGROUND AND AIMS: Treatment with tumor necrosis factor α (TNFα) antagonists in IBD patients suffers from primary non-response rates of up to 40%. Biomarkers for early prediction of therapy success are missing. We investigated the dynamics of gene expression and DNA methylation in blood samples of IBD patients treated with the TNF antagonist infliximab and analyzed the predictive potential regarding therapy outcome. METHODS: We performed a longitudinal, blood-based multi-omics study in two prospective IBD patient cohorts receiving first-time infliximab therapy (discovery: 14 patients, replication: 23 patients). Samples were collected at up to 7 time points (from baseline to 14 weeks after therapy induction). RNA-sequencing and genome-wide DNA methylation data were analyzed and correlated with clinical remission at week 14 as a primary endpoint. RESULTS: We found no consistent ex ante predictive signature across the two cohorts. Longitudinally upregulated transcripts in the non-remitter group comprised TH2- and eosinophil-related genes including ALOX15, FCER1A, and OLIG2. Network construction identified transcript modules that were coherently expressed at baseline and in non-remitting patients but were disrupted at early time points in remitting patients. These modules reflected processes such as interferon signaling, erythropoiesis, and platelet aggregation. DNA methylation analysis identified remission-specific temporal changes, which partially overlapped with transcriptomic signals. Machine learning approaches identified features from differentially expressed genes cis-linked to DNA methylation changes at week 2 as a robust predictor of therapy outcome at week 14, which was validated in a publicly available dataset of 20 infliximab-treated CD patients. CONCLUSIONS: Integrative multi-omics analysis reveals early shifts of gene expression and DNA methylation as predictors for efficient response to anti-TNF treatment. Lack of such signatures might be used to identify patients with IBD unlikely to benefit from TNF antagonists at an early time point
European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion
No full textThe aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1–2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five representing the European Society of Minimally Invasive Neurological Therapy (ESMINT)) and three nonvoting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements. First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (although in small numbers) in IVT trials. Non-randomized studies of IVT-only cohorts showed a high proportion of favorable outcomes. Expert Consensus suggests using IVT up to 24 hours unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared with BMT alone within 6 and 6–24 hours from last seen well. In both time windows, we observed a different effect of treatment depending on a) the region where the patients were treated (Europe vs Asia), b) on the proportion of IVT in the BMT arm, and c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with a National Institutes of Health Stroke Scale (NIHSS) score below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT+BMT over BMT alone (this is based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS score below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT+BMT over BMT alone in proximal and middle locations of BAO compared with distal location. While recommendations for patients without extensive early ischemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 hours after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty). © Author(s) (or their employer(s)) 2024
Impact of fibre and red/processed meat intake on treatment outcomes among patients with chronic inflammatory diseases initiating biological therapy: A prospective cohort study
Get PDFBACKGROUND: Biologic disease-modifying drugs have revolutionised the treatment of a number of chronic inflammatory diseases (CID). However, up to 60% of the patients do not have a sufficient response to treatment and there is a need for optimization of treatment strategies. OBJECTIVE: To investigate if the treatment outcome of biological therapy is associated with the habitual dietary intake of fibre and red/processed meat in patients with a CID. METHODS: In this multicentre prospective cohort study, we consecutively enrolled 233 adult patients with a diagnosis of Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis (RA), Axial Spondyloarthritis, Psoriatic Arthritis and Psoriasis, for whom biologic therapy was planned, over a 3 year period. Patients with completed baseline food frequency questionnaires were stratified into a high fibre/low red and processed meat exposed group (HFLM) and an unexposed group (low fibre/high red and processed meat intake = LFHM). The primary outcome was the proportion of patients with a clinical response to biologic therapy after 14–16 weeks of treatment. RESULTS: Of the 193 patients included in our primary analysis, 114 (59%) had a clinical response to biologic therapy. In the HFLM group (N = 64), 41 (64%) patients responded to treatment compared to 73 (56%) in the LFHM group (N = 129), but the difference was not statistically significant (OR: 1.48, 0.72–3.05). For RA patients however, HFLM diet was associated with a more likely clinical response (82% vs. 35%; OR: 9.84, 1.35–71.56). CONCLUSION: Habitual HFLM intake did not affect the clinical response to biological treatment across CIDs. HFLM diet in RA patients might be associated with better odds for responding to biological treatment, but this would need confirmation in a randomised trial. TRIAL REGISTRATION: (clinicaltrials.gov), identifier [NCT03173144]
Microfibrillar-associated protein 4 as a predictive biomarker of treatment response in patients with chronic inflammatory diseases initiating biologics:secondary analyses based on the prospective BELIEVE cohort study
Get PDFBACKGROUND: Currently, there are no reliable biomarkers for predicting treatment response in chronic inflammatory diseases (CIDs).OBJECTIVE: To determine whether serum microfibrillar-associated protein 4 (MFAP4) levels can predict the treatment response to biological therapy in patients with CIDs.METHODS: The BELIEVE study was originally designed as a prospective, multi-center cohort study of 233 patients with either rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthritis, Crohn's disease, or ulcerative colitis, initiating treatment with a biologic agent (or switching to another). Clinical assessment and blood sample collection were performed at baseline and 14-16 weeks after treatment initiation. The primary analyses included participants with available blood samples at baseline; missing data were handled as non-responders. The patients were stratified into the upper tertile of serum MFAP4 (High MFAP4) versus a combined category of middle and lower tertiles (Other MFAP4). The primary outcome was the proportion of patients with clinical response to biologic therapy after 14-16 weeks.RESULTS: 211 patients were included in the primary analysis population. The mean age was 43.7 (SD: 14.8) years, and 120 (59%) were female. Positive treatment response was observed in 41 (59%) and 69 (49%) for High MFAP4 and Other MFAP4, respectively. When adjusting for pre-specified variables (CID, age, sex, smoking status, and BMI), the adjusted OR was 2.28 (95% CI: 1.07 to 4.85) for a positive treatment outcome in the High MFAP4 group.CONCLUSION: A high MFAP4 status before initiating biological treatment is associated with a positive clinical response, when adjusting for confounding factors.</p
Additional file 2 of Longitudinal multi-omics analysis identifies early blood-based predictors of anti-TNF therapy response in inflammatory bowel disease
No full textAdditional file 2: Figure S1. Baseline signatures of the discovery cohort. Figure S2. Transcriptomic changes in response to therapy and induction of remission in the discovery cohort. Figure S3. DNA methylation patterns in response to therapy and induction of remission in the discovery cohort. Figure S4. Integration of DNA methylation and transcriptome data. Figure S5. Molecular comparisons between discovery and replication cohorts and baseline signatures of replication cohort. Figure S6. Replication of molecular signatures. Figure S7. Comparison of IBD subtypes
