Hydroxychloroquine reduces interleukin-6 levels after myocardial infarction : The randomized, double-blind, placebo-controlled OXI pilot trial

Objectives: To determine the anti-inflammatory effect and safety of hydroxychloroquine after acute myocardial infarction. Method: In this multicenter, double-blind, placebo-controlled OXI trial, 125 myocardial infarction patients were randomized at a median of 43 h after hospitalization to receive hydroxychloroquine 300 mg (n = 64) or placebo (n = 61) once daily for 6 months and, followed for an average of 32 months. Laboratory values were measured at baseline, 1, 6, and 12 months. Results: The levels of interleukin-6 (IL-6) were comparable at baseline between study groups (p = 0.18). At six months, the IL-6 levels were lower in the hydroxychloroquine group (p = 0.042, between groups), and in the on-treatment analysis, the difference at this time point was even more pronounced (p = 0.019, respectively). The high-sensitivity C-reactive protein levels did not differ significantly between study groups at any time points. Eleven patients in the hydroxychloroquine group and four in the placebo group had adverse events leading to in-terruption or withdrawal of study medication, none of which was serious (p = 0.10, between groups). Conclusions: In patients with myocardial infarction, hydroxychloroquine reduced IL-6 levels significantly more than did placebo without causing any clinically significant adverse events. A larger randomized clinical trial is warranted to prove the potential ability of hydroxychloroquine to reduce cardiovascular endpoints after myocar-dial infarction. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).Peer reviewe

Luovat ratkaisut — luovien alojen mikroyritysten liiketoiminnan kehittäminen:raportti soveltavista kokeiluista, koulutuksista ja yhteiskehittämisestä

Abstract Creative industries are one the fastest growing areas in Finnish economy as a whole. The Creative Solutions project utilized workshops for the entrepreneurs to meet and discuss various topics. The outcomes of the workshops were put into practice instantly during and/or after the meetings. Creative Solutions project developed a training programme for entrepreneurs and company personnel in creative industries. The goal was to advance commercialization and business skills of the participants. Workshops were organized on sixteen different topics. The participants came from micro-enterprises working in creative industries, which was the target group of this project. The entrepreneurs were asked to fill in a survey considering useful topics for further workshops after each meeting. The answers were used to plan and update the training programme. The survey and conversations highlighted the fact that also service industry companies benefitted from this project. These companies have generally less useful training programmes at hand. Training feedback also revealed the growing need for training in the topic of digital marketing. For example, Google and Instagram training is constantly asked for. The conclusion is, that workshops in digital marketing should be offered in the future on regular basis. This project was funded by European Social Fund, ELY Centre for North Ostrobothnia, Nivala-Haapajärvi Region NIHAK, City of Raahe and Municipality of Kärsämäki.Tiivistelmä Luovat alat kuuluvat harvoihin suomalaisiin kasvualoihin, jotka toimivat moottoreina käynnissä olevan rakennemuutoksen keskellä. Luovat ratkaisut -hankkeessa toteutettiin työpajoja, joissa yrittäjät kohtasivat eri teemojen äärellä. Työpajoissa keskityttiin käytännön tekemiseen. Työpajat työmuotona koettiin yleisesti mielekkääksi. Luovat ratkaisut -hanke toteutti luovien alojen yrittäjille ja yritysten henkilöstölle koulutuskokonaisuuden, jonka tavoitteena oli edistää kaupallistamis- ja liiketoimintaosaamista. Koulutuksia järjestettiin kuudestatoista eri aiheesta. Koulutuksiin osallistui pieniä, erityisesti luovien alojen mikroyrityksiä, jotka olivat hankkeen erityiskohderyhmää. Yrittäjiltä tiedusteltiin jokaisen koulutuksen jälkeen tarpeellisia jatkokoulutusaiheita. Niiden avulla kehitettiin tulevaa koulutussuunnitelmaa. Keskusteluissa nousi esille, että tästä hankkeesta hyötyivät myös palvelualan yritykset, jotka toimivat luovan alan mikroyrittäjinä. Heille on ollut yleisesti vähemmän tarjolla sopivaa kouluttautumistapaa. Koulutuspalautteista selvisi, että yrittäjät toivovat myöhemmin järjestettäväksi koulutuksia ennen kaikkea yritysten digitaalisesta markkinoinnista. Esimerkiksi Google- ja Instagram-koulutuksille on jatkuva tilaus. Vaikutelma on, että digitaaliseen markkinointiin liittyviä työpajoja ei voi tulevaisuudessa järjestää liikaa. Hankkeen rahoittivat Euroopan sosiaalirahasto, Pohjois-Pohjanmaan elinkeino-, liikenne- ja ympäristökeskus (ELY-keskus), Nivala-Haapajärven seutu NIHAK ry, Raahen kaupunki ja Kärsämäen kunta

Transfusion and blood stream infections after coronary surgery

Abstract The aim of this study was to evaluate the impact of blood transfusion on bloodstream infections. This study included 2764 patients who underwent isolated coronary artery bypass grafting. Blood cultures were drawn in 27.9% of patients and were positive in 3.5% of them. Blood transfusion before blood cultures were drawn (4.7% vs 1.2%, odds ratio 3.75, 95% confidence interval 1.11–12.67) and deep sternal wound infection/mediastinitis (20.0% vs 2.8%, odds ratio 7.43, 95% confidence interval 2.72–20.32) were independent predictors of a positive postoperative blood culture. Positive blood culture increased the risk of 5-year mortality (among patients with blood cultures drawn: 44.7% vs 19.6%, adjusted hazard ratio 2.10, 95% confidence interval 1.18–3.71). Exposure to blood products may increase the risk of bloodstream infection after cardiac surgery. Positive blood cultures after coronary artery bypass grafting are associated with poor late survival. These findings require validation in prospective studies

Meta-analysis of the sources of bleeding after adult cardiac surgery

Abstract Objective: The aim of this study was to pool data on the proportion and prognostic impact of sources of bleeding in patients requiring re-exploration after adult cardiac surgery. Design: Systematic review of the literature and meta-analysis. Setting: Multistitutional study. Measurements and Main Results: A literature review was performed to identify studies published since 1990 evaluating the outcome after reoperation for bleeding or tamponade after adult cardiac surgery. Eighteen studies including 5,1497 patients fulfilled the selection criteria. Reoperation for bleeding/tamponade was performed in 2,455 patients (4.6%; 95% confidence interval [CI] 3.9%–5.2%, I² 92%). These had a significantly higher risk of in-hospital/30-day mortality compared with patients not reoperated for bleeding (pooled rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52–4.32; I² 47%; 8 studies; 25,463 patients). Surgical sites of bleeding were identified in 65.7% of cases (95% CI 58.3%–73.2%; I² 94%), cardiac site bleeding in 40.9% of cases (95% CI 29.7%–52.0%; I² 94%), and mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%–37.3%; I² 94%). The main sites of bleeding were the body of the graft (20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal mammary artery harvest site (13.0%), and anastomoses (9.9%). In metaregression, surgical site bleeding was associated with a lower risk of in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003). Conclusions: Surgical site bleeding is identified in two-thirds of patients undergoing re-exploration after adult cardiac surgery. Meticulous surgical technique and systematic intraoperative checking of potential surgical sites of bleeding at the time of the original cardiac surgery may reduce the risk of such a severe complication

Characterization of coarse-grained heat-affected zones in Al and Ti-deoxidized offshore steels

Abstract Three experimental steels were studied in order to find optimal conditions for the AF formation in the coarse-grained heat-affected zone (CGHAZ). One of the steels was Al-deoxidized, while the other two were Ti-deoxidized. The main focus was to distinguish whether the deoxidation practice affected the AF formation in the simulated CGHAZ. First, two different peak temperatures and prolonged annealing were used to study the prior austenite grain coarsening. Then, the effect of welding heat input was studied by applying three cooling times from 800 °C to 500 °C in a Gleeble thermomechanical simulator. The materials were characterized using electron microscopy, energy-dispersive X-ray spectrometry, and electron backscatter diffraction. The Mn depletion along the matrix-particle interface was modelled and measured. It was found that AF formed in the simulated CGHAZ of one of the Ti-deoxidized steels and its fraction increased with increasing cooling time. In this steel, the inclusions consisted mainly of small (1–4 μm) TiOx-MnS, and the tendency for prior austenite grain coarsening was the highest

Remote ischemic preconditioning and hypoxia-induced biomarkers in acute myocardial infarction:study on a porcine model

Abstract Objectives: Remote ischemic preconditioning (RIPC) mitigates acute myocardial infarction (AMI). We hypothesized that RIPC reduces the size and severity of AMI and explored molecular mechanisms behind this phenomenon. Design: In two series of experiments, piglets underwent 60 min of the circumflex coronary artery occlusion, resulting in AMI. Piglets were randomly assigned into the RIPC groups (n = 7 + 7) and the control groups (n = 7 + 7). The RIPC groups underwent four 5-min hind limb ischemia-reperfusion cycles before AMI. In series I, the protective efficacy of RIPC was investigated by using biomarkers and echocardiography with a follow-up of 24 h. In series II, the heart of each piglet was harvested for TTC-staining to measure infarct size. Muscle biopsies were collected from the hind limb to explore molecular mechanisms of RIPC using qPCR and Western blot analysis. Results: The levels of CK-MBm (p = 0.032) and TnI (p = 0.007) were lower in the RIPC group. Left ventricular ejection fraction in the RIPC group was greater at the end of the follow-up. The myocardial infarct size in the RIPC group was smaller (p = 0.033). Western blot indicated HIF1α stabilization in the skeletal muscle of the RIPC group. PCR analyses showed upregulation of the HIF target mRNAs for glucose transporter (GLUT1), glucose transporter 4 (GLUT4), phosphofructokinase 1 (PFK1), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), enolase 1 (ENO1), lactate dehydrogenase (LDHA) and endothelial nitric oxidate synthase (eNOS). Conclusions. Biochemical, physiologic, and histologic evidence confirms that RIPC decreases the size of AMI. The HIF pathway is likely involved in the mechanism of the RIPC

Association between periodontal condition and the development of type 2 diabetes mellitus:results from a 15-year follow-up study

Abstract Aim: To study whether periodontal condition is associated with the development of type 2 diabetes mellitus (T2DM). Materials and Methods: A population‐based follow‐up study was conducted among persons born in 1935 and living in the city of Oulu, Finland (n = 395). The baseline examinations were done during 1990–1992, and the follow‐up examinations were done during 2007–2008. The data were gathered by questionnaires, laboratory tests and clinical measurements. Poisson regression models were used in the data analyses. Results: The adjusted rate ratios (RR) with 95% confidence intervals (95% CI) for the incident T2DM among subjects with 4–5 mm deep periodontal pockets (n = 98), among subjects with 6 mm deep or deeper periodontal pockets (n = 91), and among edentulous subjects (n = 118) were 1.32 (95% CI: 0.69–2.53), 1.56 (95% CI: 0.84–2.92) and 1.00 (95% CI: 0.53–1.89), respectively, compared to dentate subjects without deepened (4 mm deep or deeper) periodontal pockets (n = 88). The adjusted RR per site (the number of sites with deepened periodontal pockets as a continuous variable) was 1.02 (95% CI: 1.00–1.04). Conclusions: Poor periodontal condition may be a predictor of the development of T2DM. However, the causality between periodontal condition and the development of T2DM remains uncertain

Comparison of impact toughness in simulated coarse-grained heat-affected zone of Al-deoxidized and Ti-deoxidized offshore steels

Abstract The presence of acicular ferrite (AF) in the heat-affected zone (HAZ) of steels used offshore is generally seen as beneficial for toughness. In this study, the effects of varying fractions of AF (0–49 vol.%) were assessed in the simulated, unaltered and coarse-grained heat-affected zones (CGHAZ) of three experimental steels. Two steels were deoxidized using Ti and one using Al. The characterization was carried out by using electron microscopy, energy-dispersive X-ray spectrometry, electron backscatter diffraction and X-ray diffraction. The fraction of AF varied with the heat input and cooling time applied in the Gleeble thermomechanical simulator. AF was present in one of the Ti-deoxidized steels with all the applied cooling times, and its fraction increased with increasing cooling time. However, in other materials, only a small fraction (13–22%) of AF was present and only when the longest cooling time was applied. The impact toughness of the simulated specimens was evaluated using instrumented Charpy V-notch testing. Contrary to the assumption, the highest impact toughness was obtained in the conventional Al-deoxidized steel with little or no AF in the microstructure, while the variants with the highest fraction of AF had the lowest impact toughness. It was concluded that the coarser microstructural and inclusion features of the steels with AF and also the fraction of AF may not have been great enough to improve the CGHAZ toughness of the steels investigated