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Sanmark E, Oksanen LAH, Rantanen N, Lahelma M, Anttila VJ, Lehtonen L, Hyvärinen A, Geneid A. Aerosol generation during coughing: an observational study. J Laryngol Otol 2023; 137:442-447. [PMID: 35543098 PMCID: PMC10040286 DOI: 10.1017/s0022215122001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 has highlighted the lack of knowledge on aerosol exposure during respiratory activity and aerosol-generating procedures. This study sought to determine the aerosol concentrations generated by coughing to better understand, and to set a standard for studying, aerosols generated in medical procedures. METHODS Aerosol exposure during coughing was measured in 37 healthy volunteers in the operating theatre with an optical particle sizer, from 40 cm, 70 cm and 100 cm distances. RESULTS Altogether, 306 volitional and 15 involuntary coughs were measured. No differences between groups were observed. CONCLUSION Many medical procedures are expected to generate aerosols; it is unclear whether they are higher risk than normal respiratory activity. The measured aerosol exposure can be used to determine the risk for significant aerosol generation during medical procedures. Considerable variation of aerosol generation during cough was observed between individuals, but whether cough was volitional or involuntary made no difference to aerosol production.
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Affiliation(s)
- E Sanmark
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L A H Oksanen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - N Rantanen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - M Lahelma
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
- Faculties of Science, Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - V-J Anttila
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- HUS Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - L Lehtonen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - A Hyvärinen
- Finnish Meteorological Institute, Helsinki, Finland
| | - A Geneid
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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Rantanen N, Lieslehto J, Oksanen LMAH, Oksanen SA, Anttila VJ, Lehtonen L, Geneid A, Sanmark E. Mental well-being of healthcare workers in two hospital districts with differing COVID-19 incidence. Eur J Public Health 2022. [PMCID: PMC9594420 DOI: 10.1093/eurpub/ckac130.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives Healthcare systems and healthcare workers have been under considerable strain during the COVID-19 pandemic in many countries. Our study aimed to assess the mental well-being of Finnish healthcare workers from two hospital districts with differing COVID-19 incidence rates (HUS, Hospital district of Helsinki and Uusimaa/Helsinki University Hospital; and Kymsote, Social and Health services in Kymenlaakso region) during the first wave of the COVID-19 pandemic in spring 2020. Material and methods The data of this prospective survey study was collected during summer 2020, and a total of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated. Mental health symptoms were self-reported, and symptom criteria followed ICD-10 classification, excluding duration criteria. We divided participants into symptom categories “often/sometimes” (those who met the diagnostic criteria), and “rarely/never” (those not meeting the diagnostic criteria), and compared these groups to sociodemographic factors and factors related to work, workload, and well-being. Results Despite differences in COVID-19 incidence, the degree of mental health symptoms did not differ between HUS and Kymsote districts (p = 1). A significant relationship was found between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort, p < 0.001), insufficient recovery from work (p < 0.001), and subjective increased workload (p < 0.001). Conclusions These findings show the importance of sufficient, well-designed instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure their adequate recovery from work. Sufficient control of the epidemic to keep the burden of the healthcare system as low as possible is essential for healthcare workers’ well-being. Key messages
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Affiliation(s)
- N Rantanen
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- Clinical Research Institute HUCH, Helsinki University Hospital , Helsinki, Finland
| | - J Lieslehto
- Niuvanniemi Hospital, University of Eastern Finland , Kuopio, Finland
| | - L-MAH Oksanen
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- Department of Otorhinolaryngology and Phoniatrics, Helsinki University Hospital , Helsinki, Finland
| | | | - V-J Anttila
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- HUS Inflammation Center, Helsinki University Hospital , Helsinki, Finland
| | - L Lehtonen
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- HUS Diagnostic Center, HUSLAB, Helsinki University Hospital , Helsinki, Finland
| | - A Geneid
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- Department of Otorhinolaryngology and Phoniatrics, Helsinki University Hospital , Helsinki, Finland
| | - E Sanmark
- Faculty of Medicine, University of Helsinki, Helsingin yliopisto, Finland
- Department of Otorhinolaryngology and Phoniatrics, Helsinki University Hospital , Helsinki, Finland
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Järvinen J, Zvezdov D, Ahokas J, Sheludiakov S, Lehtonen L, Vasiliev S, Vlasenko L, Ishikawa Y, Fujii Y. Dynamic nuclear polarization and ESR hole burning in As doped silicon. Phys Chem Chem Phys 2020; 22:10227-10237. [PMID: 32352086 DOI: 10.1039/c9cp06859g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present an experimental study of the Dynamic Nuclear Polarization (DNP) of 29Si nuclei in silicon crystals of natural abundance doped with As in the temperature range 0.1-1 K and in a strong magnetic field of 4.6 T. This ensures a very high degree of electron spin polarization, extremely slow nuclear relaxation and optimal conditions for realization of Overhauser and resolved solid effects. We found that the solid effect DNP leads to the appearance of a pattern of holes and peaks in the ESR line, separated by the super-hyperfine interaction between the donor electron and 29Si nuclei closest to the donor. On the contrary, the Overhauser effect DNP mainly affects the remote 29Si nuclei having the weakest interaction with the donor electron. This leads to the appearance of a very narrow (≈3 mG wide) hole in the ESR line. We studied relaxation of the holes after burning, which is caused by the nuclear spin diffusion. Analyzing the dynamics of the hole in the spectrum with a simple one-dimensional diffusion model leads to a value of the diffusion coefficient D = 8(3) × 10-9 G2 s-1. Our data indicate that the spin diffusion is not completely prevented even in the frozen core near the donors. The emergence of the narrow hole after the Overhauser DNP may be explained by a partial "softening" of the frozen core caused by decoupling of the donor electron and remote 29Si nuclei.
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Affiliation(s)
- J Järvinen
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
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Kelly LE, Shah PS, Håkansson S, Kusuda S, Adams M, Lee SK, Sjörs G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi N. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 2017; 37:762-768. [PMID: 28383541 DOI: 10.1038/jp.2017.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK. RESULTS All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified. CONCLUSIONS Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.
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Affiliation(s)
- L E Kelly
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - S Håkansson
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - M Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - G Sjörs
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - M Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - F Rusconi
- Unit of Epidemiology, TIN Toscane Online, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - L Lehtonen
- Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - B A Darlow
- Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand
| | - K Lui
- National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - L S Feliciano
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - L Gagliardi
- Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy
| | - D Bassler
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - N Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Blomgren K, Aaltonen LM, Lehtonen L, Helmiö P. Patient injuries in operative rhinology during a ten-year period: Review of national patient insurance charts. Clin Otolaryngol 2017; 43:7-12. [DOI: 10.1111/coa.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- K. Blomgren
- Department of Otorhinolaryngology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - L.-M. Aaltonen
- Department of Otorhinolaryngology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - L. Lehtonen
- Department of Public Health; University of Helsinki and Administration Centre; Helsinki University Hospital; Helsinki Finland
| | - P. Helmiö
- Department of Vascular Surgery; Turku University Hospital and University of Turku; Turku Finland
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Sheludiakov S, Ahokas J, Järvinen J, Lehtonen L, Vainio O, Vasiliev S, Lee DM, Khmelenko VV. ESR study of atomic hydrogen and tritium in solid T 2 and T 2:H 2 matrices below 1 K. Phys Chem Chem Phys 2017; 19:2834-2842. [PMID: 28067930 DOI: 10.1039/c6cp06933a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report on the first ESR study of atomic hydrogen and tritium stabilized in solid T2 and T2:H2 matrices down to 70 mK. The concentrations of T atoms in pure T2 approached 2 × 1020 cm-3 (0.60%) and record-high concentrations of H atoms ∼1 × 1020 cm-3 (0.33%) were reached in T2:H2 solid mixtures where a fraction of T atoms became converted into H due to the isotopic exchange reaction T + H2 → TH + H. The maximum concentrations of unpaired T and H atoms were limited by their recombination which becomes enhanced by efficient atomic diffusion due to the presence of a large number of vacancies and phonons generated in the matrices by β-particles. Recombination also appeared in an explosive manner, both being stimulated and spontaneously in thick films where sample cooling was insufficient. We suggest that the main mechanism for H and T migration is physical diffusion related to tunneling or hopping to vacant sites in contrast to tunneling chemical exchange reactions which govern diffusion of H and D atoms created in H2 and D2 matrices by other methods.
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Affiliation(s)
- S Sheludiakov
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - J Ahokas
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - J Järvinen
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - L Lehtonen
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - O Vainio
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - S Vasiliev
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - D M Lee
- Institute for Quantum Science and Engineering, Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA
| | - V V Khmelenko
- Institute for Quantum Science and Engineering, Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA
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Sheludiakov S, Ahokas J, Järvinen J, Zvezdov D, Lehtonen L, Vainio O, Vasiliev S, Lee DM, Khmelenko VV. Tunneling chemical exchange reaction D + HD → D 2 + H in solid HD and D 2 at temperatures below 1 K. Phys Chem Chem Phys 2016; 18:29600-29606. [PMID: 27752662 DOI: 10.1039/c6cp05486b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report on a study of the exchange tunneling reaction D + HD → D2 + H in a pure solid HD matrix and in a D2 matrix with a 0.23% HD admixture at temperatures between 130 mK and 1.5 K. We found that the exchange reaction rates, kexHD ∼ 3 × 10-27 cm3 s-1 in the pure HD matrix, and kexD2 = 9(4) × 10-28 cm3 s-1 in the D2 matrix, are nearly independent of temperature within this range. This confirms the quantum tunnelling nature of these reactions, and their ability to proceed at temperatures down to absolute zero. Based on these observations we concluded that exchange tunneling reaction H + H2 → H2 + H should also proceed in a H2 matrix at the lowest temperatures. On the other hand, the recombination of H atoms in solid H2 and D atoms in solid D2 is substantially suppressed at the lowest temperatures as a result of a decreased probability of resonant tunneling of atoms when they approach each other.
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Affiliation(s)
- S Sheludiakov
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - J Ahokas
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - J Järvinen
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - D Zvezdov
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland. and Institute of Physics, Kazan Federal University, 18 Kremlyovskaya St., Kazan 42008, Republic of Tatarstan, Russian Federation
| | - L Lehtonen
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - O Vainio
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - S Vasiliev
- Wihuri Physical Laboratory, Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland.
| | - D M Lee
- Institute for Quantum Science and Engineering, Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA
| | - V V Khmelenko
- Institute for Quantum Science and Engineering, Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843, USA
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Stolt S, Lind A, Matomäki J, Haataja L, Lapinleimu H, Lehtonen L. Do the early development of gestures and receptive and expressive language predict language skills at 5;0 in prematurely born very-low-birth-weight children? J Commun Disord 2016; 61:16-28. [PMID: 26999726 DOI: 10.1016/j.jcomdis.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/20/2015] [Accepted: 03/06/2016] [Indexed: 06/05/2023]
Abstract
UNLABELLED It is unclear what the predictive value of very early development of gestures and language is on later language ability in prematurely born very-low-birth-weight (VLBW; birth weight ≤1500g) children. The aim of the present study was to analyse the predictive value of early gestures and a receptive lexicon measured between the ages of 0;9 and 1;3, as well as the predictive value of receptive and expressive language ability at 2;0 for language skills at 5;0 in VLBW children. The subjects were 29 VLBW children and 28 full-term children whose language development has been followed intensively between the ages of 0;9 and 2;0 using the Finnish version of the MacArthur Developmental Inventory and the Reynell Developmental Language Scales (RDLS III). At 5;0, five selected verbal subtests of the Nepsy II test and the Boston Naming Test (BNT) were used to assess children's language skills. For the first time in VLBW children, the development of gestures measured between the ages of 0;9 and 1;3 was shown to correlate significantly and positively with language skills at 5;0. In addition, both receptive and expressive language ability measured at 2;0 correlated significantly and positively with later language skills in both groups. Moreover, according to the hierarchical regression analysis, the receptive language score of the RDLS III at 2;0 was a clear and significant predictor for language skills at 5;0 in both groups. The findings particularly underline the role of early receptive language as a significant predictor for later language ability in VLBW children. The results provide evidence for a continuity between early language development and later language skills. LEARNING OUTCOMES After reading this article, readers will understand the associations between the very early (≤2 years of age) development of gestures and language (i.e. early receptive lexicon, expressive lexicon at 2;0, receptive and expressive language ability at 2;0) and the language skills at 5;0 in prematurely born very-low-birth-weight (VLBW) children. In addition, readers will understand the heterogeneity of the group of VLBW children. The information presented in this article is informative for those who work in a clinical context and who want to be able to identify those VLBW children who need support for their language development at an early age.
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Affiliation(s)
- S Stolt
- University of Helsinki and University of Oulu, Finland.
| | - A Lind
- University of Turku, Finland
| | | | - L Haataja
- Helsinki University Hospital and University of Helsinki, Finland
| | - H Lapinleimu
- Turku University Hospital and University of Turku, Finland
| | - L Lehtonen
- Turku University Hospital and University of Turku, Finland
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Niiranen K, Silvennoinen R, Laaksonen R, Airaksinen M, Lehtonen L. DD-032 The impact of computerised physician order entry on medication errors in chemotherapy. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Vainio O, Ahokas J, Järvinen J, Lehtonen L, Novotny S, Sheludiakov S, Suominen KA, Vasiliev S, Zvezdov D, Khmelenko VV, Lee DM. Bose-Einstein condensation of magnons in atomic hydrogen gas. Phys Rev Lett 2015; 114:125304. [PMID: 25860755 DOI: 10.1103/physrevlett.114.125304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Indexed: 06/04/2023]
Abstract
We report on experimental observation of Bose-Einstein condensation (BEC)-like behavior of quantized electron spin waves (magnons) in a dense gas of spin-polarized atomic hydrogen. The magnons are trapped and controlled with inhomogeneous magnetic fields and described by a Schrödinger-like wave equation, in analogy to the BEC experiments with neutral atoms. We have observed the appearance of a sharp feature in the ESR spectrum displaced from the normal spin wave spectrum. We believe that this observation corresponds to a sudden growth of the ground-state population of the magnons and emergence of their spontaneous coherence for hydrogen gas densities exceeding a critical value, dependent on the trapping potential. We interpret the results as a BEC of nonequilibrium magnons which were formed by applying the rf power.
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Affiliation(s)
- O Vainio
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - J Ahokas
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - J Järvinen
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - L Lehtonen
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - S Novotny
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - S Sheludiakov
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - K-A Suominen
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - S Vasiliev
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
| | - D Zvezdov
- Department of Physics and Astronomy, University of Turku, 20014 Turku, Finland
- Kazan Federal University, 18 Kremlyovskaya Street, Kazan 420008, Russia
| | - V V Khmelenko
- Department of Physics and Astronomy and Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - D M Lee
- Department of Physics and Astronomy and Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas 77843, USA
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11
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Sheludiakov S, Ahokas J, Järvinen J, Zvezdov D, Vainio O, Lehtonen L, Vasiliev S, Mao S, Khmelenko VV, Lee DM. Dynamic nuclear polarization of high-density atomic hydrogen in solid mixtures of molecular hydrogen isotopes. Phys Rev Lett 2014; 113:265303. [PMID: 25615349 DOI: 10.1103/physrevlett.113.265303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 06/04/2023]
Abstract
We report on magnetic resonance studies of high-density atomic hydrogen and deuterium in solid hydrogen matrices at temperatures below 1 K. Average concentrations of H atoms ≈3×10(19) cm(-3) are obtained in chemical tunneling reactions of isotope exchange with D atoms. The products of these reactions are closely located pairs of H atoms near D2 molecules with strong exchange interactions. We discovered a dynamic nuclear polarization effect on H atoms created by pumping the center of the H electron spin resonance spectrum, similar to the Overhauser effect in metals. Our results indicate that H atoms may be arranged inside molecular matrices at separations equivalent to local concentrations of 2.6×10(21) cm(-3). This opens up a way to build a metallic state of atomic hydrogen at zero pressure.
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Affiliation(s)
- S Sheludiakov
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - J Ahokas
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - J Järvinen
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - D Zvezdov
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland and Institute of Physics, Kazan Federal University, 18 Kremlyovskaya Street, Kazan 42008, Republic of Tatarstan, Russian Federation
| | - O Vainio
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - L Lehtonen
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - S Vasiliev
- Department of Physics and Astronomy, Wihuri Physical Laboratory, University of Turku, 20014 Turku, Finland
| | - S Mao
- Department of Physics and Astronomy, Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - V V Khmelenko
- Department of Physics and Astronomy, Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - D M Lee
- Department of Physics and Astronomy, Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas 77843, USA
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Stolt S, Korja R, Matomäki J, Lapinleimu H, Haataja L, Lehtonen L. Early relations between language development and the quality of mother-child interaction in very-low-birth-weight children. Early Hum Dev 2014; 90:219-25. [PMID: 24636213 DOI: 10.1016/j.earlhumdev.2014.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is not clearly understood how the quality of early mother-child interaction influences language development in very-low-birth-weight children (VLBW). AIMS We aim to analyze associations between early language and the quality of mother-child interaction, and, the predictive value of the features of early mother-child interaction on language development at 24 months of corrected age in VLBW children. STUDY DESIGN A longitudinal prospective follow-up study design was used. METHODS The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother-child interaction was assessed using PC-ERA method at 6 and at 12 months of age. RESULTS Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother-child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly. CONCLUSIONS The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions.
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Affiliation(s)
- S Stolt
- Dept. of Behavioural Sciences and Philosophy, University of Turku, Turku, Finland.
| | - R Korja
- Dept. of Child Psychiatry, Turku University Hospital and University of Turku, Finland
| | - J Matomäki
- Dept. of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - H Lapinleimu
- Dept. of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - L Haataja
- Dept. of Pediatric Neurology, Turku University Hospital and University of Turku, Turku, Finland
| | - L Lehtonen
- Dept. of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
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Kujari AM, Waris M, Lehtonen L, Ruuskanen O. Respiratory viral infections are not uncommon in neonatal intensive care units. Acta Paediatr 2014; 103:e225-8. [PMID: 24512094 PMCID: PMC7159574 DOI: 10.1111/apa.12590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/27/2014] [Accepted: 02/04/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A-M Kujari
- Department of Paediatrics; Turku University Hospital; Turku Finland
| | - M Waris
- Department of Virology; University of Turku; Turku Finland
| | - L Lehtonen
- Department of Paediatrics; Turku University Hospital; Turku Finland
| | - O Ruuskanen
- Department of Paediatrics; Turku University Hospital; Turku Finland
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Ekblad M, Gissler M, Korkeila J, Lehtonen L. Trends and risk groups for smoking during pregnancy in Finland and other Nordic countries. Eur J Public Health 2013; 24:544-51. [DOI: 10.1093/eurpub/ckt128] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Korja M, Ylijoki M, Lapinleimu H, Pohjola P, Matomäki J, Kuśmierek H, Mahlman M, Rikalainen H, Parkkola R, Kaukola T, Lehtonen L, Hallman M, Haataja L. Apolipoprotein E, brain injury and neurodevelopmental outcome of children. Genes Brain Behav 2013; 12:348-52. [PMID: 23387365 DOI: 10.1111/gbb.12024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/20/2012] [Accepted: 01/31/2013] [Indexed: 12/22/2022]
Abstract
Apolipoprotein E plays an important role in neurodegenerative processes in adulthood, whereas its neurodevelopmental role is uncertain. We aimed to study the effect of apolipoprotein E on neurodevelopment in a cohort liable to neurodevelopmental changes. The cohort consisted of very preterm (<32 gestational weeks) and/or very low birth weight (<1500 g) children, and the longitudinal follow-up protocol included sequential cranial ultrasounds during infancy, brain magnetic resonance imaging at term-equivalent age, neurological and cognitive assessment (Mental Developmental Index) at the corrected age of 2 years and cognitive and neuropsychological assessments (Wechsler Preschool and Primary Scale of Intelligence and Developmental NEuroPSYchological Assessment) at the chronological age of 5 years. Apolipoprotein E genotypes were determined from 322 children. Ultrasound and magnetic resonance imaging data were available for 321 (99.7%) and 151 (46.9%) children, respectively. Neurodevelopmental assessment data were available for 138 (42.9%) to 171 (53.1%) children. Abnormal findings in ultrasounds and magnetic resonance imaging were found in 163 (50.8%) and 64 (42.4%) children, respectively. Mild cognitive delay at the corrected age of 2 years and the chronological age of 5 years was suspected in 21 (12.3%) of 171 and 19 (13.8%) of 138 children, respectively. In the Developmental NEuroPSYchological Assessment, 47 (32.6%) of 144 children had significantly impaired performances in more than one study subtest. No associations between the apolipoprotein E genotypes and imaging findings or measured neurodevelopmental variables were found. Apolipoprotein E genotypes do not appear to have major impact on brain vulnerability or neurodevelopment in children.
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Affiliation(s)
- M Korja
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Leppänen M, Lapinleimu H, Lehtonen L, Rautava P. Growth of extremely preterm infants born in 2001-2010. Acta Paediatr 2013; 102:206-8. [PMID: 23082804 DOI: 10.1111/apa.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 09/27/2012] [Accepted: 10/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
- M. Leppänen
- Department of Pediatrics; University of Turku; Turku; Finland
| | - H. Lapinleimu
- Department of Pediatrics; University of Turku; Turku; Finland
| | - L Lehtonen
- Department of Pediatrics; University of Turku; Turku; Finland
| | - P Rautava
- Department of Public Health; University of Turku; Turku; Finland
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Abstract
BACKGROUND One of the five level III neonatal intensive care units (NICU) in Finland has used prophylactic Lactobacillus GG (LGG) for very-low-birth-weight (VLBW) infants since 1997. AIM To examine retrospectively the incidence of necrotizing enterocolitis (NEC) in all five university hospital NICUs in Finland in relation to the use of LGG during the years each unit has belonged to the Vermont Oxford Network (VON). METHODS The incidence of NEC was analysed from the national database and from the VON databases separately in all five level III NICUs and additionally in three groups according to the probiotic practice in the hospitals: prophylactic LGG group, probiotics 'on demand' group and no probiotics group. RESULTS The incidence of NEC was 4.6% vs. 3.3% vs. 1.8% in the prophylactic LGG group, the no probiotics group and the probiotics 'on demand' group [corrected] respectively; p = 0.0090, chi-square. LGG had no influence on the clinical course of NEC. CONCLUSIONS The results of this retrospective report failed to show that LGG prophylaxis protects VLBW infants from the occurrence of NEC, in contrast to previously published results. Our results call for more research regarding effective ways to administer probiotics, including data on appropriate bacteria, strain, dose and timing of administration to achieve clinically robust effects.
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MESH Headings
- Databases, Factual
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/prevention & control
- Finland/epidemiology
- Hospitals, University
- Humans
- Incidence
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal
- Lacticaseibacillus rhamnosus
- Probiotics/therapeutic use
- Retrospective Studies
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Affiliation(s)
- R Luoto
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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18
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Leppänen M, Ekholm E, Palo P, Maunu J, Munck P, Parkkola R, Matomäki J, Lapinleimu H, Haataja L, Lehtonen L, Rautava P. Abnormal antenatal Doppler velocimetry and cognitive outcome in very-low-birth-weight infants at 2 years of age. Ultrasound Obstet Gynecol 2010; 36:178-185. [PMID: 20503251 DOI: 10.1002/uog.7694] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study neurodevelopmental outcome at 2 years of corrected age in very-low-birth-weight (VLBW) (< or = 1500 g) preterm infants with abnormal fetoplacental flow. METHODS A total of 258 VLBW infants were born at Turku University Hospital between 2001 and 2006. Of these, 99 had undergone, within 1 week of delivery, antenatal Doppler assessment of blood flow in the umbilical artery (UA), fetal middle cerebral artery (MCA), descending aorta (DAo), aortic isthmus and ductus venosus and were eligible for inclusion in the study. Postnatally brain pathology was assessed by serial ultrasound and magnetic resonance imaging in 86 of the neonates and brain volume was measured in 80. Cognitive development was evaluated at 2 years of corrected age in 83 infants using the Bayley Scales of Infant Development-II. Motor development was assessed using the Hammersmith Infant Neurological Examination. RESULTS On univariate analysis, abnormal pulsatility index (PI) in the UA and an abnormal UA-PI/MCA-PI ratio (P = 0.04 and P = 0.003, respectively) as well as increases in both the DAo-PI and in the DAo-PI/MCA-PI ratio (P = 0.03 and P = 0.02, respectively), were associated with adverse cognitive outcome at 2 years of age. However, when controlling for cerebral volume using multivariate analysis, the association between abnormal antenatal Doppler characteristics and cognitive outcome became statistically non-significant, which indicated the determinant role of the volume reduction. Motor development was not associated with antenatal Doppler indices. CONCLUSION Abnormal antenatal Doppler indices are associated with adverse cognitive outcome at 2 years in VLBW infants. Our findings suggest that this association may be mediated through brain volume.
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Affiliation(s)
- M Leppänen
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Rautava L, Häkkinen U, Korvenranta E, Andersson S, Gissler M, Hallman M, Korvenranta H, Leipälä J, Peltola M, Tammela O, Lehtonen L. Health and the use of health care services in 5-year-old very-low-birth-weight infants. Acta Paediatr 2010; 99:1073-9. [PMID: 20219051 DOI: 10.1111/j.1651-2227.2010.01737.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We aimed to study the effect of prematurity, time of birth and level of birth hospital on morbidity and the use of health care services at age 5. METHODS This national study included all very-low-birth-weight infants (VLBWI, <32 gestational weeks or birth weight < or =1500 g) born in Finnish level II or III hospitals in 2001-2002 (n = 918), and full-term controls (n = 381). Parental questionnaires and register data were used to compare morbidity, and the use of health care services between VLBWI and full-term controls, and within VLBWI according to the time of birth and birth hospital level. RESULTS Cerebral palsy, retinopathy of prematurity, other ophthalmic problems, respiratory infections, asthma or chronic lung disease, and inguinal hernia were overrepresented in VLBWI compared with the controls. VLBWI had more outpatient and inpatient days than the controls. The time of birth and birth hospital level were not associated with the use of services or with prematurity-related morbidity. CONCLUSION Although morbidity and the use of health care services were increased in the surviving VLBWI, the average use of services was relatively small at age 5. In surviving VLBWI, the time of birth and the birth hospital level did not affect morbidity or the use of services.
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Affiliation(s)
- L Rautava
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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20
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Munck P, Haataja L, Maunu J, Parkkola R, Rikalainen H, Lapinleimu H, Lehtonen L. Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006. Acta Paediatr 2010; 99:359-66. [PMID: 19912142 DOI: 10.1111/j.1651-2227.2009.01589.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. METHODS A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. RESULTS The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). CONCLUSION Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians.
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Affiliation(s)
- P Munck
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Abstract
AIM To assess the long-term developmental outcome of very low birth weight children with postnatally developing caudothalamic cysts. METHODS Five very low birth weight children with postnatal caudothalamic cysts were examined using cranial ultrasound and brain Magnetic Resonance Imaging as neonates, the Bayley Scales of Infant Development, 2nd edition, and the Hammersmith Infant Neurological Examination at 2 years of corrected age, and with the Wechsler Preschool and Primary Scale of Intelligence-Revised and the standardization version of NEPSY II at 5 years of age. The Magnetic Resonance Imaging of the brain was repeated at 5 years of age. The developmental outcome at 5 years of age was compared with that of 23 very low birth weight children with normal brain structure. RESULTS A cognitive level below normal and/or neuropsychological impairments was seen in all the children with caudothalamic cysts as well as in those with normal brain structure. CONCLUSION Very low birth weight children with postnatally developing caudothalamic cysts had cognitive and neuropsychological impairments similar to very low birth weight children without such cysts.
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Affiliation(s)
- A Lind
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Abstract
AIM To investigate whether promoting shorter ventilator treatment decreases the number of painful procedures and the use of analgesics in preterm infants. METHODS Retrospective patient chart review of all preterm infants in one Neonatal Intensive Care Unit (NICU) was carried out in 2000 (n = 240) and 2005 (n = 206). Between these cohorts, early nasal continuous positive airway pressure (nCPAP) application and early extubation policy were introduced. RESULTS Fewer infants were intubated (22 vs. 32%, p = 0.03), the duration of ventilator treatment decreased (6.7 SD 11.3 vs. 9.0 SD 11.1 days, p < 0.001) and nCPAP treatment became more common (41 vs. 25%, p < 0.001) in 2005 than in 2000. Similarly, the infants' exposure to painful procedures did not decrease significantly (61.9 SD 98.5 vs. 67.1 SD 104.3 procedures, p = 0.32) but the procedures related to respiratory support were fewer (45.2 SD 79.5 vs. 68.9 SD 91.1 procedures, p < 0.001) in 2005 than in 2000. In addition, the amount of pain medication used was significantly lower in 2005 than in 2000. One day on a ventilator included more painful procedures than a day on nCPAP (11.2 95% CI: 11.0-11.5 vs. 4.2 95% CI: 4.1-4.4 procedures, p < 0.001) during both study years. CONCLUSION Early nCPAP and early extubation policies were successfully implemented in an NICU resulting in less invasive respiratory support. This was associated with fewer painful procedures and less pain medication in the preterm infants who required respiratory support. Despite this positive effect, the number of painful procedures in all preterm infants stayed at the same level. Our results provide further support for the use of nCPAP in preterm infants.
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Affiliation(s)
- A Axelin
- Department of Nursing Science, University of Turku, Turku, Finland.
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Peltoniemi OM, Kari MA, Lano A, Yliherva A, Puosi R, Lehtonen L, Tammela O, Hallman M. Two-year follow-up of a randomised trial with repeated antenatal betamethasone. Arch Dis Child Fetal Neonatal Ed 2009; 94:F402-6. [PMID: 19531521 DOI: 10.1136/adc.2008.150250] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Weekly repeated antenatal corticosteroid treatment improves respiratory outcome but decreases fetal growth and may impair neurodevelopmental outcome. We have previously reported that a single repeat betamethasone (BM) dose neither decreased fetal growth nor improved the outcome of preterm infants during the first hospitalisation. OBJECTIVE To study prospectively whether a single repeat dose of BM influences neurodevelopment and growth within 2 years. DESIGN Women with imminent delivery before 34.0 gestational weeks were eligible if they remained undelivered for >7 days after a single course of antenatal BM. After stratification, a single repeat dose of BM (12 mg) or placebo was given. The children underwent neurological and psychometric examinations and a speech evaluation at a corrected age of 2 years. SETTING Prospective, blinded evaluation following the randomised multicentre trial. PATIENTS 259 (82%) surviving infants completed the 2-year follow-up, 120 in the BM group and 139 in the placebo group. RESULTS The rate of survival without severe neurodevelopmental impairment was similar in both groups (BM 98%, placebo 99%). The risk of cerebral palsy (BM 2%, placebo 1%), growth or re-hospitalisation rates (BM 60%, placebo 50%) did not differ between the groups. CONCLUSIONS A single repeat dose of antenatal BM tended not to influence physical growth or neurodevelopment at 2 years of age.
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Affiliation(s)
- O M Peltoniemi
- Department of Paediatrics, University of Oulu, FIN-90014 University of Oulu, Finland.
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Attila P, Förström L, Hannuksela M, Karvonen J, Lehtonen L, Salo OP. Clotrimazole—hydrocortisone, hydrocortisone and propylene glycol liniment in the treatment of seborrhoeic dermatitis of the scalp. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639209088720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brandt H, Attila P, Ahokas T, Förström L, Järvinen T, Keskitalo R, Lehtonen L, Plosila M, Rita H, Suramo ML. Erythromycin acistrate - an alternative oral treatment for acne. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639409081836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nöjd N, Ilmarinen T, Lehtonen L, Skottman H, Suuronen R, Hyttinen J. Using MEA system in verifying the functionality of retinal pigment epithelium cells differentiated from human embryonic stem cells. IFMBE Proceedings 2009. [DOI: 10.1007/978-3-540-89208-3_547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
AIM To investigate visiting frequency of family members, including mother, father, siblings and grandparents and associated factors during hospitalisation of preterm infants. METHODS The study included all premature (< 37 weeks) infants born in Tampere University Hospital in 1997-1998 admitted to the neonatal intensive care unit (NICU) with a birth weight less than 2500 g (n = 210). Maternal and infant data and visits made by family members were compiled from the infants' hospital records. RESULTS The length of the infants' hospitalisation varied from 2 to 133 days (median 26, quartiles 19, 45). Mothers visited the NICU on average 6.7 days/week; fathers 4.8 days/week. Mothers visited less frequently the lower the gestational age and the longer the distance between home and hospital. Fathers visited less frequently if distance from home to hospital was longer and if the infant had siblings. A total of 92% of siblings and 80% of grandparents visited the hospital. CONCLUSIONS The results showed active visiting by the parents in the NICU. A lower gestational age was associated with lower visiting frequency for mothers. In contrast, more practical limitations such as geographical distance and other children to be taken care of had greater effect on the visiting frequency for fathers.
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Affiliation(s)
- R Latva
- Department of Child Psychiatry, University of Tampere, Tampere University Hospital, Finland.
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Affiliation(s)
- J Kirjavainen
- Department of Child Neurology, Turku University Hospital, Finland.
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30
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Abstract
Levosimendan is a new calcium sensitizer developed for the treatment of congestive heart failure. Experimental studies indicate that levosimendan increases myocardial contractility and dilates both the peripheral and coronary vessels. Its positive inotropic effect is based on calcium-dependent binding of the drug to cardiac troponin C. It also acts as an opener of ATP-dependent potassium channels in vascular smooth muscle, thus inducing vasodilation. Although levosimendan acts preferentially as a calcium sensitizer it has also demonstrated selective phosphodiesterase III inhibitory effects in vitro. However, this selective inhibition does not seem to contribute to the positive action at pharmacologically relevant concentrations. Levosimendan has an active metabolite, OR-1896. Similarly to levosimendan, the metabolite exerts its positive inotropic and vasodilatory effects on myocardium and vasculature. The elimination half-life of levosimendan is about 1 hour. Thus, with intravenous administration, the parent drug rapidly disappears from the circulation after the infusion is stopped. The active metabolite, however, has a half-life of approximately 80 hours, and can be detected in circulation up to 2 weeks after stopping a 24-hour infusion of levosimendan. The intravenous formulation of levosimendan has been studied in several randomized comparative studies in patients with decompensated heart failure. Both patients with ischemic and non-ischemic etiology have participated in the studies. Levosimendan produces significant, dose-dependent increases in cardiac output, stroke volume and heart rate, and decreases in PCWP, mean blood pressure, mean pulmonary artery pressure, mean right atrial pressure and total peripheral resistance. With a loading dose, the effects on PCWP and cardiac ouput are seen within few minutes. There is no sign of development of tolerance even with a prolonged infusion up to 48 hours. Cardiac performance is improved with no significant increases in oxygen consumption or potentially malignant rhythm disorders. Due to the formation of an active metabolite, the hemodynamic effects are maintained up to several days after stopping levosimendan infusion. Compared to dobutamine, levosimendan produces similar increase in cardiac output but profoundly greater decrease in pulmonary capillary wedge pressure. On the contrary to dobutamine, the hemodynamic effects are not attenuated with concomitant beta-blocker use. Levosimendan has been shown to have favourable effects on symptoms of heart failure superior to placebo and at least comparable to dobutamine. Mortality and morbidity in levosimendan treated patients has been shown to be significantly lower when compared to dobutamine or placebo treated patients. The most common adverse events associated with levosimendan treatment are headache and hypotension, as a likely consequence of the vasodilating properties of the compound. In conclusion, levosimendan offers a new effective option for the treatment of acutely decompensated heart failure. Unlike traditional inotropes, levosimendan seems also to be safe in terms of morbidity and mortality.
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Affiliation(s)
- M Kivikko
- Clinical Research, Cardiology and Critical Care, Orion Pharma, Orionintie 1, P.O. Box 65, FIN-02101 Espoo, Finland.
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Heikkinen T, Valkonen H, Lehtonen L, Vainionpää R, Ruuskanen O. Hospital admission of high risk infants for respiratory syncytial virus infection: implications for palivizumab prophylaxis. Arch Dis Child Fetal Neonatal Ed 2005; 90:F64-8. [PMID: 15613580 PMCID: PMC1721807 DOI: 10.1136/adc.2003.029710] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the rates of hospital admission for respiratory syncytial virus (RSV) infection among children born at different gestational ages. To assess the theoretical impact of palivizumab prophylaxis on admissions for RSV infection. DESIGN Retrospective cohort study of children born in 1991-2000. SETTING Tertiary care university hospital. METHODS Data on all children born during the 10 year period were combined with information on laboratory confirmed RSV infections in these children until the end of 2002. The theoretical impact of palivizumab on RSV associated admissions was estimated by applying the current recommendations for prophylaxis to the study population and using the observed rates of admission in the calculations. INTERVENTIONS None. MAIN OUTCOME MEASURES Rates of RSV infection and hospital admission in different subgroups of children. RESULTS Children with chronic lung disease (CLD) were admitted for RSV infection at a rate of 12.0%. The corresponding rates in children born at </=28 or 29-32 weeks gestation were 7.1% and 6.8% respectively. Children born at </=32 weeks gestation accounted for 6.6% of all admissions due to RSV. Of 586 children who would have met the criteria for palivizumab prophylaxis, 27 (4.6%) were admitted with RSV during the presumed prophylactic period. The number needed to treat to prevent one admission for RSV infection was 15 for children with CLD (with a total cost of 75 000) and 43 for children without CLD born at </=32 weeks gestation (with a total cost of 215 000). CONCLUSIONS The rates of hospital admission for RSV infection in premature infants were substantially lower than those in most previous reports from other countries. Determination of the local rates of RSV admissions in different groups of children would be useful in making decisions about the use of palivizumab.
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Affiliation(s)
- T Heikkinen
- Department of Paediatrics, Turku University Hospital, FIN-20520 Turku, Finland.
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Põder P, Eha J, Sundberg S, Antila S, Heinpalu M, Loogna I, Planken U, Rantanen S, Lehtonen L. Pharmacokinetic-pharmacodynamic interrelationships of intravenous and oral levosimendan in patients with severe congestive heart failure. Int J Clin Pharmacol Ther 2003; 41:365-73. [PMID: 12940594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE To assess the pharmacokinetic-pharmacodynamic (PK-PD) interrelations after a 6-hour continuous infusion and a 2 mg single oral dose of levosimendan in patients with congestive heart failure (CHF). METHODS This was an open-label, non-randomized Phase II trial in 29 patients with New York Heart Association (NYHA) class III-IV CHF, comprising 2 study days. On the first day, patients were given 6-hour levosimendan infusion with the dose 0.2 microg/kg/min. After a 1-week washout, the patients received a 2 mg single oral dose of levosimendan. Heart rate-corrected electromechanical systole QS2i was the primary variable. Secondary variables were heart rate (HR), systolic (sBP) and diastolic blood pressure (dBP) and 24-hour ambulatory ECG (Holter). RESULTS QS2i shortened from 515 ms at baseline to 506 ms at the end of 6-hour infusion (p = 0.007). After 2 mg single dose, QS2i shortened at 2 h after drug intake from 532 ms at baseline to 525 ms (p = 0.006). The effect was similar also at 8 h (532 ms vs 526 ms, p = 0.017). Mean of maximum shortening of QS2i observed during the infusion was 22 ms (p < 0.0001) and 17 ms after 2 mg single oral dose (p < 0.0001). The concentration-effect loops for QS2i showed a clear counter-clockwise hysteresis with both modes of administration. sBP and dBP decreased both during infusion and after 2 mg oral dose. HR remained unchanged during both modes of administration. CONCLUSIONS Both 6-hour infusion and 2 mg single dose of levosimendan showed that levosimendan possesses moderate inotropic and vasodilatory effects in patients with severe congestive heart failure, which could be described as counter-clockwise hysteresis. It seemed that the vasodilatory effect appeared earlier than the inotropic effect.
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Affiliation(s)
- P Põder
- Cardiovascular Projects, Research Centre, Orion Pharma, Espoo, Finland.
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Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther 2002; 40:465-71. [PMID: 12395979 DOI: 10.5414/cpp40465] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Levosimendan is a new calcium sensitizer with additional vasodilatory properties developed for the short-term intravenous treatment of congestive heart failure. The aims of the present study were to determine the pharmacokinetics and hemodynamic effects of levosimendan and its metabolites during and after a 24-hour levosimendan infusion. METHODS The study was an open-label, non-randomized, phase II study in 2 centers. Twelve patients with NYHA III-IV heart failure received 0.2 microg/kg/min continuous infusion of levosimendan for 24 hours. Blood samples for the determination of plasma concentrations of the parent drug and the metabolites were drawn repeatedly during the infusion and the 2-week follow-up period. Heart rate from Holter recordings and blood pressure were measured. RESULTS The elimination half-life of levosimendan was 1.3 hours and that of the metabolites 75-78 hours. The mean maximum increase in heart rate of 10 bpm (p < 0.005) and the mean maximum decreases in systolic and diastolic blood pressure of 12 mmHg and 8 mmHg (p < 0.05 for both), respectively, were observed during the first day after stopping levosimendan infusion. The hemodynamic effects slowly declined during the follow-up, and after 1 week no statistically significant differences compared with baseline were observed. No increase in ventricular arrhythmias was seen. CONCLUSION A 24-hour infusion of levosimendan induces hemodynamic effects lasting several days after stopping the infusion. The prolongation of the effects beyond the infusion period is most likely due to an active metabolite with a long half-life.
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Affiliation(s)
- M Kivikko
- Orion Pharma, Cardiovascular Projects, Espoo, Finland.
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Abstract
METHOD We studied mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. RESULTS The main findings suggest that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The problems in the interaction were most pronounced between the fathers and infants in the severe colic group. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. CONCLUSIONS The problems in early family interaction may threaten the well-being of families with excessively crying infants and they therefore deserve special attention from the health care professionals.
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Affiliation(s)
- H Räihä
- Department of Psychology, University of Turku, Turky, Finland.
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Follath F, Cleland JGF, Just H, Papp JGY, Scholz H, Peuhkurinen K, Harjola VP, Mitrovic V, Abdalla M, Sandell EP, Lehtonen L. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002; 360:196-202. [PMID: 12133653 DOI: 10.1016/s0140-6736(02)09455-2] [Citation(s) in RCA: 708] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Levosimendan, a novel calcium sensitiser, improves myocardial contractility without causing an increase in myocardial oxygen demand. We compared the effects of levosimendan and dobutamine on haemodynamic performance and clinical outcome in patients with low-output heart failure. METHODS Patients were recruited into a multicentre, randomised, double-blind, double-dummy, parallel-group trial. Under continuous haemodynamic monitoring, an initial loading dose of levosimendan of 24 microg/kg was infused over 10 min, followed by a continuous infusion of 0.1 microg kg(-1) min(-1) for 24 h. Dobutamine was infused for 24 h at an initial dose of 5 microg kg(-1) min(-1) without a loading dose. The infusion rate was doubled if the response was inadequate at 2h. The primary endpoint was the proportion of patients with haemodynamic improvement (defined as an increase of 30% or more in cardiac output and a decrease of 25% or more in pulmonary-capillary wedge pressure) at 24 h. Analyses were by intention to treat. FINDINGS 103 patients were assigned levosimendan and 100 dobutamine. The primary haemodynamic endpoint was achieved in 29 (28%) levosimendan-group patients and 15 (15%) in the dobutamine group (hazard ratio 1.9 [95% CI 1.1-3.3]; p=0.022). At 180 days, 27 (26%) levosimendan-group patients had died, compared with 38 (38%) in the dobutamine group (0.57 [0.34-0.95]; p=0.029). INTERPRETATION In patients with severe, low-output heart failure, levosimendan improved haemodynamic performance more effectively than dobutamine. This benefit was accompanied by lower mortality in the levosimendan group than in the dobutamine group for up to 180 days.
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Affiliation(s)
- F Follath
- Department of Internal Medicine, University Hospital Zürich, Zürich, Switzerland.
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Laine M, Lehtonen L, Nieminen MS. [Calcium sensitizers--a new group of drugs that increase myocardium contractility]. Duodecim 2002; 116:2181-3. [PMID: 12017622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Salonen JH, Rimpiläinen M, Lehtonen L, Lehtonen OP, Nikoskelainen J. Measurement of the D-arabinitol/L-arabinitol ratio in urine of neutropenic patients treated empirically with amphotericin B. Eur J Clin Microbiol Infect Dis 2001; 20:179-84. [PMID: 11347667 DOI: 10.1007/s100960100472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to evaluate the diagnostic significance of the D-arabinitol/L-arabinitol ratio in urine of neutropenic patients with suspected fungal infection. D-arabinitol/L-arabinitol ratios were determined in 373 serial urine samples of 104 patients with haematological malignancies receiving empirical amphotericin B treatment for suspected invasive fungal infection. Twenty-eight (8%) urine samples obtained from 17 (16%) patients were positive (ratio > or =4). Eight (47%) patients had positive urine samples at the initiation of empirical amphotericin B treatment and the rest from 7 to 30 days after empirical therapy was started. Several urine samples were positive in six patients. Only one of the five patients with candidemia had elevated D-arabinitol/L-arabinitol ratios (persistent Candida krusei fungaemia). Four patients with transient candidemia and seven patients with invasive mould infections were negative. Patients who died during the study period had significantly higher D-arabinitol/L-arabinitol ratios than patients who survived (P=0.0002). Pneumonia was the most common manifestation of infection (53% of patients with elevated D-arabinitol/L-arabinitol ratios) and was associated with an especially high mortality (67%). The present study shows that elevated urine D-arabinitol/L-arabinitol ratios are common in febrile, neutropenic patients. However, the urine arabinitol test did not detect transient candidemia at elevated levels during the course of infection. Furthermore, D-arabinitol/L-arabinitol ratios were often elevated in the late phase of infection only. This contests the use of this test in guiding the initiation of antifungal therapy. The detection of elevated arabinitol levels in neutropenic patients during empirical amphotericin B treatment is associated with poor prognosis.
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Affiliation(s)
- J H Salonen
- Department of Medicine, Turku University Central Hospital, Finland.
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Abstract
OBJECTIVE To compare nighttime sleep structure between infants with colic and a control group. STUDY DESIGN Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age. RESULTS Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003). CONCLUSION Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.
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Affiliation(s)
- J Kirjavainen
- Department of Pediatric Neurology and Pediatrics, Turku University Hospital, Turku, Finland
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Antila S, Jarvinen A, Honkanen T, Lehtonen L. Pharmacokinetic and pharmacodynamic interactions between the novel calcium sensitiser levosimendan and warfarin. Eur J Clin Pharmacol 2000; 56:705-10. [PMID: 11214780 DOI: 10.1007/s002280000204] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study the effects of possible interactions between levosimendan and warfarin on pharmacokinetics and pharmacodynamics. Furthermore, the effects of levosimendan on blood coagulation were investigated. METHODS Open, randomised cross-over design with two treatment phases was used. During one phase, levosimendan (0.5 mg four times daily) was given orally to ten healthy subjects for 9 days. On the fourth treatment day with levosimendan, a single oral dose of warfarin (25 mg) was given. Pharmacokinetic parameters of levosimendan from the third and fourth treatment days were compared with each other. During the other treatment phase the subjects received only a single dose of warfarin. Pharmacokinetic parameters of warfarin alone were compared with those determined after concomitant administration of levosimendan. Changes in blood coagulation parameters were evaluated after levosimendan and warfarin alone and after concomitant administration. RESULTS Warfarin did not change the pharmacokinetics of levosimendan. The distribution volume of warfarin was higher and elimination half-life shorter after concomitant levosimendan administration than after warfarin alone. However, concomitant levosimendan administration did not potentiate the effects of warfarin on blood coagulation assessed using activated partial thromboplastin time (APTT) and thromboplastin time (TT-SPA). Levosimendan alone for 3 days did not change APTT or TT-SPA values. There were no changes in the protein binding of levosimendan or warfarin upon concomitant administration. Continuous treatment with oral levosimendan caused headache, which was probably due to cerebral vasodilation. CONCLUSIONS Concomitant levosimendan administration did not potentiate the effect of warfarin on blood coagulation after a single dose. Levosimendan itself had no effects on blood coagulation.
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Affiliation(s)
- S Antila
- Orion Pharma, Research Centre, Espoo, Finland.
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Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, Lehikoinen P, Någren K, Lehtonen L, Voipio-Pulkki LM. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther 2000; 68:522-31. [PMID: 11103755 DOI: 10.1067/mcp.2000.110972] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS Levosimendan, a novel calcium-dependent calcium sensitizer of the myocardial contractile proteins, also enhances diastolic relaxation and induces peripheral vasodilation by opening potassium channels. To assess the combined energetical effects of levosimendan infusion in vivo, we performed positron emission tomography in patients with decompensated chronic heart failure. METHODS AND RESULTS Eight hospitalized patients with New York Heart Association functional class III or IV heart failure received levosimendan or placebo intravenously in a randomized double-blind cross-over study. During steady-state, dynamic positron emission tomography with [11C]acetate was used to assess myocardial oxygen consumption and [15O]H2O to measure myocardial blood flow. Cardiac performance and dimensions were assessed by pulmonary artery catheterization and echocardiography. Compared with healthy volunteers, myocardial oxygen consumption during placebo was elevated in the right ventricle but comparable in the left ventricle. During administration of levosimendan, cardiac output increased by 32% (P = .002) mainly because of higher stroke volume. Coronary, pulmonary, and systemic vascular resistance values were significantly reduced. Mean myocardial blood flow increased from 0.76 to 1.02 mL/min/g (P = .033). Levosimendan was neutral on myocardial oxygen consumption and left ventricular efficiency, but it improved right ventricular mechanical efficiency by 24% (P = .012). CONCLUSIONS Levosimendan has an energetically favorable short-term profile in the treatment of congestive heart failure. It enhances cardiac output without oxygen wasting, particularly by improving efficiency in the right ventricle.
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Affiliation(s)
- H Ukkonen
- Department of Medicine, Turku University Hospital and Turku PET Centre, Finland
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Abstract
The aim of this study was to determine if transdermal penetration of levosimendan, a novel positive inotropic drug, could be enhanced and controlled by formulation modifications. Penetration of levosimendan across human epidermis in vitro was determined using abdominal excised skin and diffusion cells. Predicted steady-state plasma concentrations of levosimendan were estimated using permeabilities and pharmacokinetic parameters of levosimendan. For penetration enhancement we used different pH values, co-solvents, cyclodextrins, surfactants, penetration enhancers, liposomes, and iontophoresis. Sodium lauryl sulfate, ethanol, oleic acid, and soya phosphatidylcholine or their combinations clearly increased levosimendan permeation across the skin in vitro. Iontophoresis was also an efficient method to increase transdermal permeation of levosimendan. A hydrophilic co-solvent/penetration enhancer is needed to achieve better permeability of levosimendan across the skin. In conclusion, transdermal delivery of levosimendan can be significantly increased by formulation modification. Based on kinetic calculations, therapeutic plasma concentrations may be achievable transdermally.
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Affiliation(s)
- R Valjakka-Koskela
- Pharmaceutical Development Department, Orion Corporation Orion Pharma, P.O. Box 1780, 70701, Kuopio, Finland.
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Simelyte E, Rimpiläinen M, Lehtonen L, Zhang X, Toivanen P. Bacterial cell wall-induced arthritis: chemical composition and tissue distribution of four Lactobacillus strains. Infect Immun 2000; 68:3535-40. [PMID: 10816508 PMCID: PMC97639 DOI: 10.1128/iai.68.6.3535-3540.2000] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To study what determines the arthritogenicity of bacterial cell walls, cell wall-induced arthritis in the rat was applied, using four strains of Lactobacillus. Three of the strains used proved to induce chronic arthritis in the rat; all were Lactobacillus casei. The cell wall of Lactobacillus fermentum did not induce chronic arthritis. All arthritogenic bacterial cell walls had the same peptidoglycan structure, whereas that of L. fermentum was different. Likewise, all arthritogenic cell walls were resistant to lysozyme degradation, whereas the L. fermentum cell wall was lysozyme sensitive. Muramic acid was observed in the liver, spleen, and lymph nodes in considerably larger amounts after injection of an arthritogenic L. casei cell wall than following injection of a nonarthritogenic L. fermentum cell wall. The L. casei cell wall also persisted in the tissues longer than the L. fermentum cell wall. The present results, taken together with those published previously, underline the possibility that the chemical structure of peptidoglycan is important in determining the arthritogenicity of the bacterial cell wall.
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Affiliation(s)
- E Simelyte
- Department of Medical Microbiology, Turku Immunology Centre, Turku Graduate School of Biomedical Sciences, Turku University, Turku, Finland.
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Abstract
OBJECTIVE To evaluate the effectiveness of infant massage compared with that of a crib vibrator in the treatment of infantile colic. METHODS Infants <7 weeks of age and perceived as colicky by their parents were randomly assigned to an infant massage group (n = 28) or a crib vibrator group (n = 30). Three daily intervention periods were recommended in both groups. Parents recorded infant crying and given interventions in a structured cry diary that was kept for 1 week before (baseline) and for 3 weeks during the intervention. Parents were interviewed after the first and third weeks of intervention to obtain their evaluation of the effectiveness of the given massage or crib vibration. RESULTS At baseline, the mean amount of total crying was 3.6 (standard deviation: 1.4) hours/day in the massage group infants and 4.2 (2.0) hours/day in the vibrator group infants. The mean amount of colicky crying was 2.1 (standard deviation: 1.1) hours/day and 2.9 (1.5) hours/day, respectively. The mean number of daily intervention periods was 2.2 in both groups. Over the 4-week study, the amount of total and colicky crying decreased significantly in both intervention groups. The reduction in crying was similar in the study groups: total crying decreased by a mean 48% in the massage group and by 47% in the vibrator group, and colicky crying decreased by 64% and 52%, respectively. The amount of other crying (total crying minus colicky crying) remained stable in both groups over the intervention. Ninety-three percent of the parents in both groups reported that colic symptoms decreased over the 3-week intervention, and 61% of the parents in the massage group and 63% of the parents in the crib vibrator group perceived the 3-week intervention as colic reducing. CONCLUSIONS Infant massage was comparable to the use of a crib vibrator in reducing crying in colicky infants. We suggest that the decrease of total and colicky crying in the present study reflects more the natural course of early infant crying and colic than a specific effect of the interventions.
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Affiliation(s)
- V Huhtala
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Abstract
Levosimendan is a new inodilator, whose mechanism of action includes calcium sensitization of contractile proteins and the opening of ATP-dependent potassium channels. The combination of positive inotropy with anti-ischemic effects of K-channel opening offers many potential benefits in comparison to currently available intravenous inotropes, that are more or less contraindicated in patients with ongoing myocardial ischemia. Levosimendan has been extensively studied in various animal models of heart failure, in which the drug has increased contractility without adverse effects on diastolic function. These results have been repeated in patients with heart failure, by whom levosimendan dose-dependently increases cardiac output and reduces pulmonary capillary wedge pressure. On higher doses, the drug can induce tachycardia and hypotension. In clinical trials, drug-induced ventricular arrhythmia have been rare. Recently, trials in patients with decompensated heart failure have suggested that short-term intravenous treatment with levosimendan might improve the survival of these critical patients. These results highlight the importance of adequate treatment of the acute heart failure patients for their long-term outcome.
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Affiliation(s)
- L Lehtonen
- Department of Clinical Pharmacology, University of Helsinki, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 360, FIN-00290 Helsinki, Finland.
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Toivonen L, Viitasalo M, Sundberg S, Akkila J, Lehtonen L. Electrophysiologic effects of a calcium sensitizer inotrope levosimendan administered intravenously in patients with normal cardiac function. J Cardiovasc Pharmacol 2000; 35:664-9. [PMID: 10774799 DOI: 10.1097/00005344-200004000-00021] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Provocation of fatal cardiac arrhythmias has limited the use of inotropic agents as heart failure therapy. Calcium sensitization of the myofilaments might increase inotropy without influencing cardiac electrophysiology unless modified by ancillary properties of the drugs. Electrophysiologic effects of a calcium sensitizer inotrope levosimendan were examined in short-term intravenous administration in humans. Variables were determined in 10 patients with normal cardiac function during a preceding control phase and levosimendan infusion yielding a high therapeutic concentration of 110 (+/-22) microg/L. Levosimendan increased heart rate by 9 beats/min (p < 0.01) on average and shortened the sinus node recovery time and AH interval. At the tested cycle lengths, levosimendan shortened the effective refractory periods in the atrioventricular node by 40-63 ms (p < 0.05), in the atrium by 22-33 ms (p < 0.001), and in the ventricle by 5-9 ms (p < 0.005) on average. Levosimendan increased ventricular monophasic action potential duration by 9-17 ms at 50% (p < 0.001) and by 5-15 ms (p = 0.07) at 90% levels of repolarization on average. The QT interval during spontaneous rhythm and atrial pacing remained unchanged although increased slightly when corrected to sinus rate (p < 0.001). The observations indicate that levosimendan in short-term administration facilitates impulse formation and conduction in cardiac slow-response tissue, enhances recovery of excitability in the myocardium, and may delay ventricular repolarization. The effects on the ventricle were not substantial, and therefore the likelihood of provoking serious cardiac arrhythmias is not estimated to be high.
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Affiliation(s)
- L Toivonen
- Division of Cardiology, Helsinki University Central Hospital, Finland.
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Sundberg S, Lehtonen L. Haemodynamic interactions between the novel calcium sensitiser levosimendan and isosorbide-5-mononitrate in healthy subjects. Eur J Clin Pharmacol 2000; 55:793-9. [PMID: 10805056 DOI: 10.1007/s002280050699] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The new calcium sensitiser levosimendan also possesses vasodilatory effects due to potassium-channel opening. The aim of the present study was to assess the possible haemodynamic interactions between levosimendan and isosorbide-5-mononitrate in young healthy men. METHODS The study was crossover, placebo controlled, double blind, randomised, and it comprised of four study days with one medication--levosimendan, isosorbide-5-mononitrate, levosimendan plus isosorbide-5-mononitrate or placebo--given on each. Levosimendan was administered i.v. as an initial bolus dose of 12 microg/kg over 10 min, followed by a continuous infusion of 0.2 microg/kg/min for a total time of 2 h. Isosorbide-5-mononitrate (20 mg) was given orally as a single dose. Leg blood flow and venous capacity (venous occlusion plethysmography), cardiac output (impedance cardiography), skin blood flow (laser-Doppler flowmetry), blood pressure and heart rate were recorded at baseline, and 20 min, 1 h, 2 h, 4 h and 6 h after the start of the infusion. An orthostatic test was performed at baseline and at 2 h 15 min. Twelve healthy, male subjects were included. Their mean age was 24 years (range 20-34 years). RESULTS Levosimendan increased leg blood flow by 32%, and no additive effect of the combination of levosimendan and isosorbide-5-mononitrate was observed. The effects of levosimendan on heart rate and blood pressure were minimal and in close conformity with previous studies. In general, there were no additive effects of the combination compared with each drug alone at rest. The only additive effect was seen in the orthostatic response. Heart rate increased by 40 beats min(-1) with the combination (95% confidence interval compared with placebo 11-24 beats min(-1)), by 30 beats min(-1) with levosimendan (2-15 beats min(-1)), by 28 beats min(-1) with isosorbide-5-mononitrate (1-15 beats min(-1)), and by 22 beats min(-1) with placebo. Furthermore, three subjects were unable to stand upright for the stipulated time with the combination, and the orthostatic test had to be discontinued prematurely. There were no changes in the conduction intervals in the electrocardiogram on any of the treatments. The combination had no influence on the occurrence of headache compared with isosorbide-5-mononitrate alone. CONCLUSION No major additive haemodynamic effects of the combination of levosimendan and isosorbide-5-mononitrate compared with each drug alone could be observed at rest. However, during an orthostatic test, the circulatory response was significantly potentiated with the combination, and three of the subjects were unable to stand upright for the stipulated time.
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Affiliation(s)
- S Sundberg
- Orion Pharma, Orion Research Centre, Espoo, Finland
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Abstract
Site specific bioavailability and metabolism of levosimendan was studied in ten dogs by placing intestinal access port catheters in different parts of the gastrointestinal tract. 14C-labelled levosimendan (0.1 mg/kg) was administered intravenously, by gastric tube and directly through catheters that were placed in the duodenum, jejunum and ileum. Plasma samples were collected and radioactivity in the different organs and tissues was measured. The results of the present study showed that bioavailability of levosimendan was high varying from 71 to 86% after extravascular administration. Metabolite OR-1855 concentrations in the plasma were about 3-4 times higher after administration to the ileum compared to the other administration routes. It can be concluded that the bioavailability of levosimendan is not affected by site specific administration. The bacteria or enzymes responsible for the metabolism of levosimendan are located in the lower parts of the gastrointestinal tract.
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Affiliation(s)
- S Antila
- Orion Pharma, PO Box 65, 02101, Espoo, Finland.
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Toivanen P, Hansen DS, Mestre F, Lehtonen L, Vaahtovuo J, Vehma M, Möttönen T, Saario R, Luukkainen R, Nissilä M. Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis. J Clin Microbiol 1999; 37:2808-12. [PMID: 10449457 PMCID: PMC85385 DOI: 10.1128/jcm.37.9.2808-2812.1999] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of the present study was to find out whether patients with ankylosing spondylitis (AS) carry fecal Klebsiella strains that belong to serotypes or species specific for AS. Somatic serotypes (O groups), capsular (K) serotypes, and biochemically identified species were determined for fecal klebsiellae isolated from 187 AS patients and 195 control patients. The controls were patients with fibromyalgia or rheumatoid arthritis. The 638 isolates of Klebsiella that were obtained represented 161 strains; 81 from AS patients and 80 from the controls. The average number of Klebsiella strains per patient was 1.7 for the AS group and 1.5 for the control group. The most common O group was O1, which was observed for isolates from 23 of 187 AS patients and 24 of 195 control patients. Next in frequency was group O2, which was observed for isolates from 17 AS patients and 15 control patients. Regarding the K serotypes, 59 different types were identified, revealing a heterogeneous representation of Klebsiella strains, without a predominance of any serotype. By biochemical identification, Klebsiella pneumoniae was the most frequently occurring species, being found in 45 AS patients and 45 control patients. Next in the frequency was K. oxytoca, which was observed in 26 AS patients and in 29 control patients. K. planticola and K. terrigena occurred in only a minority of patients. Altogether, when analyzed either separately or simultaneously according to O groups, K serotypes, and biochemically identified species, no evidence of the existence of AS-specific Klebsiella strains was obtained. These findings do not indicate participation of Klebsiella in the etiopathogenesis of AS.
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Affiliation(s)
- P Toivanen
- Turku Immunology Centre, Department of Medical Microbiology, Turku University, Turku, Finland.
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Follath F, Cleland J, Just H, Papp J, Scholz H, Peuhkurinen K, Harjola V, Mitrovic V, Abdulla M, Lehtonen L. Efficacy and safety of intravenous levosimendan in severe low-output heart failure. A randomized, double-blind comparison to dobutamine (The LIDO-Study). J Card Fail 1999. [DOI: 10.1016/s1071-9164(99)91560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Simelyte E, Rimpiläinen M, Rantakokko K, Lehtonen L, Zhang X, Aho H, Isomäki P, Toivanen P. Tissue distribution and persistence of arthritogenic and non-arthritogenic Eubacterium cell walls. Clin Exp Rheumatol 1999; 17:281-8. [PMID: 10410260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To study the tissue distribution and persistence of arthritogenic and non-arthritogenic Eubacterium cell walls (CWs), using arthritogenic Eubacterium aerofaciens and non-arthritogenic Eubacterium limosum. METHODS Eubacterium aerofaciens or Eubacterium limosum CW was injected into Lewis rats intraperitoneally. Inflammatory changes in the synovium and periarticular tissues were graded histologically. On days 14, 28 and 56 after the injection, the presence of CW in the liver, spleen, mesenteric lymph nodes and synovium was studied by indirect immunofluorescence. In parallel, CW-derived muramic acid in the liver and spleen was measured by gas chromatography-mass spectrometry. In addition, serum TNF-alpha, IL-1 beta and IL-10 concentrations were determined by ELISA. RESULTS Systemic injection of Eubacterium aerofaciens CW, but not of Eubacterium limosum CW, resulted in chronic arthritis. Both E. aerofaciens and E. limosum CWs were observed in the liver and spleen at all of the time points studied. In addition, Eubacterium limosum CW was present in non-arthritic synovium on day 14. It was not, however, detected in the synovium or lymph nodes on days 28 and 56, in clear contrast to the rats injected with E. aerofaciens CW. According to the analysis by gas chromatography-mass spectrometry, non-arthritogenic E. limosum CW had accumulated in the liver cells on days 14 and 28 after the injection to a greater extent than arthritogenic E. aerofaciens CW, leading to a lesser distribution in the other organs. A weak trend was observed suggesting that the production of TNF-alpha and IL-1 beta, but not of IL-10, is stimulated better by arthritogenic CW than by non-arthritogenic CW. CONCLUSION Our results indicate that non-arthritogenic CWs are handled by the rat's defence mechanisms in a different way than arthritogenic CWs. The tissue distribution and persistence of CWs play a role in arthritogenicity, but additional factors must exist to determine why the CWs of certain bacteria are arthritogenic and those of others are not.
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Affiliation(s)
- E Simelyte
- Turku Immunology Centre, Departments of Medical Microbiology and Pathology, Turku University, Turku, Finland
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