Search

Objectives: Since selective cerebral perfusion (SCP) has been used in aortic arch surgical procedures, the core temperature during lower body circulatory arrest (LBCA) has been steadily rising. Simultaneously, the use of a frozen elephant trunk (FET) graft has been increasing. The safe period of LBCA in relation to spinal cord ischaemic tolerance in combination with segmental artery occlusion by the FET procedure has not been defined. Methods: Sixteen pigs were assigned to undergo 65 (n = 10) or 90 min (n = 6) of SCP at 28°C with LBCA in combination with occlusion of the 8 uppermost segmental arteries in the thoracic (Th) aorta (15–20 cm FET, Th8-level). The follow-up period consisted of a 6-h intensive period and a 5-day observation period. Near-infrared spectroscopy of the collateral network was used to determine spinal cord oxygenation. The neurological status of the patients was evaluated daily, and the brain and the spinal cord were harvested for a histopathological analysis. Results: Five out of 6 pigs after 90 min and 1 out of 10 pigs after 65 min of LBCA died within 48 h of multiorgan failure. Of the survivors in the 65-min group, 6 out of 9 had paraparesis/paraplegia; the remaining 3 reached normal function. The lone survivor after 90 min of LBCA was paraplegic. Nadir near-infrared spectroscopy of the collateral network values at Th8 and Th10 were 34 (±5) and 39 (±4), and they were reached within 35 min of SCP in both groups. Conclusions: An extended FET graft with LBCA and SCP durations >65 min at 28°C results in a poor outcome.

Tiivistelmä Lähtökohdat: Suuskannereita alettiin hyödyntää oikomishoidossa vuosituhannen vaihteessa, ja nykyään skannerien markkinat kasvavat jatkuvasti sitä mukaa, kun kalvo-oikominen yleistyy. Artikkelissa käsitellään suuskannerien toimintaperiaatteita ja käyttömahdollisuuksia ortodontiassa sekä vertaillaan niitä perinteisiin jäljentämismenetelmiin. Lisäksi luodaan katsaus skannauksen kehitykseen ja tämänhetkisiin markkinoihin. Menetelmät: Tutkimusmenetelmänä käytettiin kirjallisuuskatsausta. Aihetta käsitteleviä tuoreita artikkeleita etsittiin PubMed- ja Scopus-tietokannoista. Tulokset ja johtopäätökset: Markkinoilla olevat skannerit hyödyntävät hyvin monenlaisia teknologioita. Suuskannerien tarkkuudessa on eroavaisuuksia: eräät skannerit tuottavat tarkempia digitaalisia jäljennöksiä kuin muut. Eroista huolimatta skannerien on osoitettu olevan kliinisesti riittävän tarkkoja, mutta niiden hinnat ovat vielä korkeita. Monissa tutkimuksissa on todettu, että opetteluvaiheen jälkeen työn tehokkuus ja potilastyytyväisyys ovat skannerilla työskenneltäessä merkittävästi paremmat kuin perinteisiä jäljennösmenetelmiä käytettäessä. Hammaslääkärin työhön kuuluu jatkuva oman ammattitaidon kehittäminen. Uusi oikojasukupolvi on edellistä valmiimpi hyödyntämään digitaalisia laitteita, ja kynnys niiden käyttöönottoon madaltuu arkisen viestintäteknologian yleistyessä.

Objectives: The authors aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR), taken from the FinnValve registry. Design: Nationwide, retrospective observational study. Setting: Five Finnish university hospitals participated in the registry. Participants: A total of 6,463 patients who underwent SAVR (n = 4,333) or TAVR (n = 2,130). Interventions: Patients who underwent TAVR or SAVR with a bioprosthesis with or without coronary revascularization. Measurements and Main Results: The incidence of postoperative stroke after SAVR was 3.8%. In multivariate analysis, the number of transfused RBC units (odds ratio [OR], 1.098; 95% confidence interval [CI], 1.064–1.133) was one of the independent predictors of postoperative stroke. The incidence of stroke increased, along with the severity of perioperative bleeding, according to the European Coronary Artery Bypass Grafting (E-CABG) bleeding grades were as follows: grade 0, 2.2% (reference group); grade 1, 3.4% (adjusted OR, 1.841; 95% CI, 1.105–3.066); grade 2, 5.5% (adjusted OR, 3.282; 95% CI, 1.948–5.529); and grade 3, 14.8% (adjusted OR, 7.103; 95% CI, 3.612–13.966). The incidence of postoperative stroke after TAVR was 2.5%. The number of transfused RBC units was an independent predictor of stroke after TAVR (adjusted OR, 1.155; 95% CI, 1.058–1.261). The incidence of postoperative stroke increased, along with the severity of perioperative bleeding, as stratified by the E-CABG bleeding grades: E-CABG grade 0, 1.7%; grade 1, 5.3% (adjusted OR, 1.270; 95% CI, 0.532–3.035); grade 2, 10.0% (adjusted OR, 2.898; 95% CI, 1.101–7.627); and grade 3, 30.0% (adjusted OR, 10.706; 95% CI, 2.389–47.987). Conclusions: Perioperative bleeding requiring RBC transfusion and/or reoperation for intrathoracic bleeding is associated with an increased risk of postoperative stroke after

Background: Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis. Methods: The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction. Results: Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively. Conclusions: Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration: The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

Donor sperm is widely used in infertility treatments. The purpose of the study was to investigate, whether use of donor sperm in intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments affect maternal and perinatal risks compared with spontaneously conceived pregnancies or use of partner sperm in IUI, IVF or ICSI. We provide a systematic review and meta-analyses on the most clinically relevant obstetric and perinatal outcomes after use of donor sperm compared with partner sperm: hypertensive disorders of pregnancy, preeclampsia, low birth weight, and preterm birth. Our meta-analyses showed an increased risk for preeclampsia (pooled adjusted odds ratio (aOR) 1.77, 95% CI 1.26–2.48) and hypertensive disorders of pregnancy (pooled aOR 1.55, 95%, CI 1.20–2.00) in pregnancies resulting from IUI with donor sperm compared with IUI with partner sperm. No increased risk was seen for low birth weight or preterm birth after the use of donor sperm in IUI compared with the use of partner sperm in IUI. Subgroup analysis for singletons only did not change these results. The meta-analysis on low birth weight showed a lower risk after in IVF with donor sperm compared with IVF with partner sperm (pooled aOR 0.89, 95% CI 0.83–0.94). For hypertensive disorders of pregnancy, preeclampsia and preterm birth, no difference was found between IVF with donor sperm vs. partner sperm. Patients need to be informed about the moderately increased risk of hypertensive disorders of pregnancy and preeclampsia in pregnancies after IUI with donor sperm.

Tiivistelmä. Kandidaatintutkielmani aihe on Pohjois-Pohjanmaan varhaisimman paloapuyhdistyksen eli Kalajoen paloapuyhdistyksen alkuvaiheet vuosien 1860–1870 välillä, sekä niiden tarkastelu yhteisvastuun käsitteen kautta. Tutkielma käsittelee syitä ja tarvetta paloapuyhdistysten perustamiselle 1800-luvun lopun Suomessa Kalajoen paloapuyhdistystä esimerkkitapauksena käyttäen. Yhteisvastuun käsitteen näkökulman valitsin, koska paloapuyhdistykset ja niitä seuranneet vakuutusyhdistykset ja -yhtiöt ovat vaikuttaneet yhteiskuntaan myös sosiaalisessa mielessä. Tutkimuskysymykset ovat seuraavat: milloin ja miksi perustettiin Pohjois-Pohjanmaan ensimmäinen paloapuyhdistys? Millaiset olivat kyseisen yhdistyksen alkuvaiheet? Lähdeaineistona tutkimuksessa ovat LähiTapiola Pohjoisen arkistoissa Oulussa ja Kalajoella sijaitsevat aineistot. Kalajoen toimipisteen arkiston aineistoista osa on irrallisia kirjeitä tai kirkossa julkisesti seurakunnalle luettuja kuulutuksia, osa taas tilikirjoja ja kokousten pöytäkirjoja. Tutkimuskirjallisuus koostuu sekä historiatieteellisistä että populaarihistorian teoksista, sillä kattavaa aiempaa tutkimusta ei aiheesta ole tehty.