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The aim of this work was to investigate the feasibility of titanium dioxide (TiO2) photocatalysis for imitation of phase I metabolism of selected anabolic steroids. The role of the solvent composition and the time of UV exposure in the TiO2 photocatalysis were also investigated. TiO2 photocatalysis has been reported to produce mainly the same phase I reaction types formed in drug metabolism in vitro and in vivo. The selected anabolic steroids were testosterone, methyltestosterone, metandienone, nandrolone and stanozolol. Products from TiO2 photocatalysis were compared to products formed in microsomal incubations (HLM). Comparison was made on the basis of same mass, retention time and similarity of the product ion spectra. The samples were analyzed with ultra performance liquid chromatography (UPLC) and quadrupole time-of-flight mass spectrometry (Q-TOF). Electrospray ionization (ESI) in positive ion mode was used for ionization and product ion scan with two different collision energy was used for collision induced dissociation of the steroids and the reaction products. TiO2 photocatalysis is a simple and fast method. For all the steroids studied, the main reactions observed both in TiO2 photocatalysis and microsomal incubations were dehydrogenation, hydroxylation and combination of these two. Several isomers with same mass and retention time were formed. In addition, dihydroxylation and dihydroxylation+dehydrogenation products of stanozolol were observed both in TiO2 photocatalysis, but these were different isomers in different systems. In most cases the product ion spectra of isomers with same retention time were similar but the weak intensity of some peaks caused uncertainty in the interpretation of spectra. TiO2 photocatalysis might be useful in fast screening of possible drug metabolites. However the feasibility of TiO2 photocatalysis needs to be further studied because the differences in stereochemistry in TiO2 photocatalysis and microsomal incubations. If TiO2 photocatalytic reactions can be scaled up, it might be possible to produce standard compounds for example for doping laboratories.

Oxysterols and vitamin D related compounds are found to be biologically active in brain. They might be involved in different psychiatric and neurodegenerative diseases. These compounds have traditionally been analysed from tissues using somewhat laborious and time-consuming gas chromatograpy and liquid chromatography mass spectrometric methods. To the side of these methods ambient desorption ionization methods have been developed. The advantage of these methods is rapid and easy operation. Usually minimal or no sample pretreatment is required. In addition these methods can be applied to imaging of for example tissues. The aim of this work was to study if it is possible to detect certain oxysterols and vitamin D related compounds from rat brain tissue samples with desorption atmospheric pressure photoionization (DAPPI). The compounds chosen to this study were cholesterol, vitamin D3, 25-hydroxyvitamin D3, 7-dehydrocholesterol, desmosterol and 7-ketocholesterol. DAPPI is especially suitable for efficient ionization of this kind of neutral and non-polar compounds. Detected MS and MSn spectras of the brain tissue samples were compared to those obtained from standard compounds. As a result we could not detect vitamin D3, 25-hydroxyvitamin D3, 7-dehydrocholesterol, desmosterol from rat brain samples with DAPPI. Excluding vitamin D3 it is possible that those other analytes are present at the spectras of brain samples but there is some other compound with same mass which makes the reliable identification of studied compounds impossible. 7-ketocholesterol and cholesterol were the only compunds we detected from brain tissue sections. 7-ketocholesterol can be formed via auto-oxidation in samples containing excess amount of cholesterol. According to this study it is impossible to say if the detected 7-ketocholesterol is formed endogenously or during sample preparation and analysis.

Medicine shortages have been an increasing problem in the pharmaceutical industry for several years. While the causes of these shortages have been widely researched, they have been found to be diverse and the root causes are difficult to identify. The pharmaceutical care system has been formed over a long period of time, which has led to a growing problem of shortages for various reasons. This study aims to investigate he views of different pharmaceutical sectors on what reforms to the mandatory reserve supply law could help to prevent and shorten the medicine shortages. The study was conducted through a thematic interview. Abductive analysis and thematic analysis were selected as the method of analysis. The study found that mandatory reserve supply is successful in acting as a buffer against short-term shortages, but that a comprehensive reform of the law would be necessary. According to the study, the reform of the law is linked to a wide range of issues. More flexible processes in regulatory aspects, the profitability of the Finnish market, and hospital procurements are closely related to the mandatory reserve supply law. The reform of the mandatory supply list could bring flexibility to exemptions to maintain lower stock levels by renewing the list of medicines and categorizing them into different groups. The act on public contracts law and the mandatory supply reserve law should be better coordinated to avoid wastage and thus ensure Finland's adequate competitiveness However, it should be noted that ensuring Finland's competitiveness and reducing shortages is not solely the responsibility of the mandatory reserve supply law. It also requires extensive international cooperation and it is also believed that bringing production back to Europe and even to Finland is crucial to shorten medicines shortages.

Nearly all drugs that are abused release dopamine in the nucleus accumbens, the end point structure of mesolimbic dopamine pathway. This why effect of those drugs is closely attached to dopaminergic system. It seems that function of mesolimbic dopamine pathway is necessary for rewarding effects of drugs as cocaine and amphetamine. However rewarding effects of ethanol seems to mediate routes despite of mesolimbic dopamine pathway. This conclusion is a result of several studies that have showed that destruction of synapses of in nucleus accumbens have no effect on ethanol drinking of rats. So it might be that the possible place were effects of ethanol mediate beside of straight stimulation of nucleus accumbens, are GABA- and opioidergic medium spiny neurons that project from nucleus accumbens to ventral pallidum and also from ventral pallidum back to nucleus accumbens. Ventral pallidum is the structure of brain that is thought to be the last common pathway of brain reward circuitry. Ventral pallidum is also found to mediate reinforcement of pleasure of natural rewarders and also drugs that are abused. Meaning of this study was to find how opioidreceptors in ventral pallidum control the drinking of ethanol. The method of study was observe how opioidergic drugs (µ-, δ-, κ-agonist and -antagonist) that are microinjected in brain of AA-rats mediate voluntary ethanol drinking of these animals. Hypothesis of this study was that activation of opioidreceptors in ventral pallidum leads to lower consumption of ethanol and inactivation of these receptors leads to higher consumption of ethanol. Study was performed in National institute for health and welfare, Department of Alcohol, Drugs an Addiction, in research group of Kalervo Kiianmaa. There were used ethanol prefering AA-rats which were microinjected in ventral pallidum with opioidergic drugs. Study involved 72 male rats form generation F99. There were six groups and each had 12 rats. Before the actual trial rats were taught to drink 10 % ethanol/water-solution voluntary. Surgery and placement of canulaes were done with stereotactic device. Bilateral guide canulaes were placed above the ventral pallidum. Each drug was given in three different size doses and also ringer's solution was given as a control. Volume on injections were in each drug and with the ringer's solution 0,3 µl and rate of injection was 0,3 µl/min. Total trial involved four experiment days (three with the drugs and one with the ringer's solution). Injections were given in mixed order. Immediately after injection rats were moved in their homecages and they were given drinking bottle which was filled with ethanol. The consumption of ethanol was observed in time of 10, 20, 30, 50, 70 and 90 minutes. After all experiment's were done rats were decapitated and the places of injections were checked from brain slices that were stained with thionine. Results were analyzed with repeated measures ANOVA and if difference between groups were found the post hoc test were done with Dunnett's test. If the statistical difference were found with repeated measures ANOVA the result were analyzed also in exact time point with ANOVA and Dunnett's test. The only significant result was found with µ-opioidreceptoragonist (DAMGO). It lowered the ethanol consumption significantly. The drop in ethanol consumption was dose dependent and was seen with two highest doses of DAMGO. Clearest difference was seen at the first 50 minutes after rats had started drinking ethanol. The second highest dose of µ-opioidreceptorantagonist (CTOP) had a little tendency to elevate ethanol consumption and was near to be a significant (p=0.08). There were found no effects with other drugs. The main conclusion of this study was that activation of µ-opioidreceptors in the ventral pallidum lowers consumption of ethanol in AA-rats. Inhibition the µ-opioidreceptors had a mild effect of elevating ethanol consumption but this could not be taken as reliable and more studies are needed to be done. δ- and κ-opioidreceptor activation or inhibition had no effect in ethanol consumption in these rats. Conclusions made by these results give support to the theory of role of ventral pallidum as a part of brain reward circuitry. When these results are compared to studies were GABAergic drugs are injected in ventral pallidum and ethanol consumption is observed and also with the knowledge of how these drugs affect the cell's membrane potential, there can be made conclusion that inhibition the activity of ventral pallidum has effects that block pleasure mechanisms that interface with ethanol.

Extracellular vesicles (EVs) are nano-sized lipid bilayer-delimited particles, released by cells. They take part in intercellular communication by their molecular composition and are part of both physiological and pathophysiological functions. EVs can be extracted from bodily fluids, and they are particularly abundant in blood. The purpose of this thesis was to evaluate the use of Raman spectroscopy in the characterization of EVs. Raman spectroscopy is an analysis method based on the interaction of light and matter, and the inelastic scattering of light, and it is used to get information on the biochemical composition of a substance. Principal component analysis (PCA) was used to investigate if Raman spectroscopy could differentiate two different platelet-derived EV samples, a red blood cell-derived EV-sample and a red blood cell-derived reference material. Evaluation of the characterization also included a stability study of these samples, where it was examined if any temperature dependent changes occurred that could be detected by Raman spectroscopy. Additionally, the applicability of Raman spectroscopy for lipoprotein contamination detection was evaluated by examining if purification of an EV sample decreased the intensity of carotenoid peaks typical for lipoprotein spectra. Raman spectroscopy was able to differentiate all three EV samples and the red blood cell-derived reference material from each other. The most clear differences were found between red blood cell and platelet-derived samples, due to for example the characteristic haemoglobin peaks of red blood cell-derived samples. Differences were also found between the two platelet EV samples, which were thought to implicate difference in protein compositions. The characterization of red blood cell-derived samples proved to be difficult because haemoglobin contained in the samples covered most of the other signal from the samples. Stability studies implicated that during fridge storage the carotenoid peak intensity of platelet-derived EV samples decreases due to the degradation of carotenoids. In the red blood cell-derived samples, no differences assignable to changes in some specific components of the samples were observed. Contamination studies suggested the intensity of the carotenoid peaks may increase due to purification of the sample. This was counter to the assumption and may suggest the carotenoids of the EV samples are not from lipoprotein contamination, but part of the EV composition. In conclusion, Raman spectroscopy proved to be a promising method for characterization and identification of different EV samples.

Barcode-assisted medication administration can be used to prevent medication errors in pediatric hospital settings, as the medicine and the patient can be safely identified during the drug preparation and administration. The use of barcode-assisted medication administration has been examined in a few qualitative studies. In addition to the benefits, many challenges related to the implementation of this new workflow have been identified. The aim of this study was to identify facilitators and barriers related to the use of barcode-assisted medication administration in a children's hospital. The topic has not been studied in Finland before. A qualitative focus group study was carried out at HUS Helsinki University Hospital in the Department of Children and Adolescents. Ward pharmacists (n=14) were selected for the focus groups (n=3) by purposive sampling to identify persons using barcode-assisted medication administration on their daily work. Two researchers conducted the inductive content analysis independently, after which a consensus was formed first with these researchers and later with the entire research group. COREQ checklist was used to support detailed reporting and to consider the factors that might affect to the reliability of the study in each phase of the study. Four main themes were identified from the data; the barriers, the risk behavior caused by the barriers, the facilitators and the development ideas. The barriers included challenges related to negative attitudes of the end-users, barcodes on drug packages and labels, use of the electronic health record system, workstations and equipment, as well as orientation, competence and management. The barriers caused risk behavior that was related either to the system or to the end-user. On the other hand, the facilitators were associated with the positive experience of the end-user, the increase in expertise and multi-professional cooperation, the functions of the electronic health record system that supported the preparation and administration of the medicines, as well as the benefits of the barcode-assisted medication administration workflow. The development ideas aimed to remove the barriers and the risk behavior related to the use of barcode-assisted medication administration. The users found that the use of barcode-assisted medication administration increased patient and medication safety, although there were still many challenges associated with the new workflow. Barcode-assisted medication administration can be used to reduce medication errors and protect patients from adverse events. The results of this study can be used to develop the usability of barcode technology and their implementation.

As the population becomes older and the amount of multimorbid patients increases, also health care spending increases. New care models are needed where patients’ needs are taken into consideration by providing preventive and patient-centred care. In Finland and internationally, new ways to treat elderly, chronically ill patients have been developed. One of the new models is the health and care plan model. This longitudinal, randomised, controlled trial studied the health and care plan model’s impact on healthcare costs, patients’ physical functioning and patients’ quality of life. The aim of the study was to study the cost-effectiveness of the health and care plan model compared to standard care practice. The goal of this study was to study if rational pharmacotherapy and self-management support can prevent the decline in physical functioning, the decline in quality of life and the increase in health service use and costs among elderly population. This study was conducted between 2014-2018 as a multi-disciplinary cooperation between Tornio health station, University of Helsinki Faculty of Pharmacy and Alatornio pharmacy. The patients in this study were over 75-year old, multimorbid, community dwelling, polypharmacy patients. The patients in the intervention group received an interview based clinical medication review and were formed a medication plan. Furthermore, the patients in the intervention group were planned a health and care plan that was combined with the medication plan into a comprehensive self-management plan in a multi-disciplinary meeting. A case manager was appointed for the patients in the intervention group and the case manager could be contacted by the patients in the intervention group at any point of the study if there arose a non-acute concern with the patient’s health. The patients in the control group were conducted a prescription review based on the information available in the electronic health records system and continued receiving the standard care practice. Cost and effectiveness data were gathered from the patients over the period of two years. The effectiveness data were gathered at Tornio health station where the intervention and control group’s quality of life was measured with the SF-36 generic quality of life measure and physical functioning was measured with Short Physical Performance Battery (SPPB). The quality of life data gathered with SF-36 were transformed into one preference based single index score SF-6D to calculate the quality of life and quality adjusted life years (QALY). Data about the use of health services were extracted from the electronic health records system and transformed into costs by using the national reference costs. At the beginning of the study, the intervention and control group were statistically significantly similar. During the two-year follow-up, no statistically or clinically significant differences were observed between the intervention and control group in their quality of life, in their physical functioning or in the costs of used health services. However, in the intervention group, the cost of used health services was on average 2 406 euros smaller than those of the control group’s during the two-year follow-up. The health and care plan model was cost-effective compared to standard care practice. The incremental cost-effectiveness ratio was -64 504 € per one QALY. Based on this study, it is recommended to support the self-management and physical functioning of the elderly with an intervention like health and care plan model to decrease the health care spending. The results of this study can be applied to Finnish healthcare system to decrease the health care spending of multimorbid, community dwelling and polypharmacy elderly patients. The use of real-world evidence increases the reliability of this study.

Zebrafish (Danio rerio) is a vertebrate model organism. It is suited for many phases of drug development process like toxicological studies. The major advantage of using zebrafish is the possibility to conduct high-throughput screens on a whole vertebrate animal. However, there is not as much knowledge about zebrafish as there is about other model organisms. Therefore there might be differences between zebrafish and humans that affect the use of zebrafish as a model in the drug development process. The purpose of this thesis was to characterize the structure of the zebrafish oxytocin system and assess the role of oxytocin on zebrafish behaviour. In humans defects in the oxytocin system have been linked to many psychiatric disorders like autism. If the mammalian and zebrafish oxytocin systems resembled each other functionally and structurally, it would enable the use of zebrafish as a model when studying the role of oxytocin in pathophysiology of diseases and also in oxytocin system related drug development. The structure and development of zebrafish oxytocin system was studied by staining adult zebrafish brain cryosections and larval brains with antibodies made against mammalian oxytocin. The specificity of the antibodies to recognize zebrafish oxytocin was determined by absorption and cross-reactivity controls. The role of oxytocin on zebrafish locomotion was studied by inhibiting the splicing of oxytocin messenger RNA with morpholino oligonucleotides (MOs). The MOs were used to address the relevance of the model in pharmacology, since the zebrafish oxytocin receptors have not been expressed and pharmacologically characterized. In zebrafish oxytocin was produced in the cells of the preoptic nucleus. There were thick oxytocin fibers towards the pituitary and also thinner fibers into areas in the telencephalon, diencephalon, mesencephalon and rhombencephalon. One of the MOs was able to inhibit the production of oxytocin with a dose that did not cause morphological abnormalities. The MO reduced the locomotor activity of the fish, but the specificity of the MO has to be determined. The structure of the zebrafish oxytocin system resembles mammalian oxytocin system in terms of the location of oxytocin cells and fiber projections. Therefore zebrafish seems a suitable model organism for oxytocin research. However, the structure of the zebrafish oxytocin receptor system and the effect of oxytocin on other behavioural aspects have to be determined in order to further evaluate the applicability of zebrafish for oxytocin research.

Parkinson's disease is a neurodegenerative disease which is characterized by progressive loss of dopaminergic neurons in the substantia nigra and formation of intracellular Lewy bodies. α-synuclein is an essential part of Lewy bodies. In addition, mutations in the α-synuclein gene have been found to cause rare familial forms of Parkinson's disease. Animal models of Parkinson's disease are created by neurotoxins, transgenic animals and viral vectors. Transgenic animal models and viral vector models seem to reflect the pathology of Parkinson's disease better than the traditional neurotoxin models. In the transgenic animal models, the transgene and the promoter used in the expression of the transgene guide the pathology and motor dysfunctions that the animal model exhibits. In the viral vector models, it is important to use a suitable animal strain and a correct viral serotype in order to express the transgene sufficiently enough in the laboratory animals. The aim of the study was to investigate the ability of adeno-associated viral vector (AAV1-vector) to transfect WT- or A53T-α-synuclein gene into the striatum or the substantia nigra, and the effects of their overexpression on motor functions and concentrations of striatal dopamine and its metabolites in mice. In addition, the effect of a prolyl endopeptidase (PREP) inhibitor on the overexpression of A53T-α-synuclein in the mouse nigrostriatal pathway was studied, as PREP has been found to stimulate the aggregation of α-synuclein and therefore perhaps to increase neurotoxicity of α-synuclein. There were no statistically significant differences between the groups in the motor function tests (locomotor activity, rotarod and balance beam walk). Green fluorescent protein immunostaining showed that the GFP gene was weakly transfected into the striatum by the AAV1-vector, and no overexpression was observed. There were only minor differences in the striatal concentrations of dopamine and its metabolites. Finally, PREP-activity measurements showed that PREP-inhibitor (KYP-2047) treatment had poorly reduced PREP-activity. In this study, the viral vectors did not induce the overexpression of α-synuclein, although previously AAV2- and AAV6-vectors have been efficient in mice and rats. High PREP-activities that were found in most of the samples probably resulted from failed installations of mini-pumps that delivered the PREP-inhibitor. While in this study the viral vectors were not a successful attempt in the creation of an animal model of Parkinson's disease, they are an important method to model Parkinson's disease in the future.