Outcome after mitral valve surgery for mitral valve regurgitation

Abstract The repair of degenerative mitral valve regurgitation has been shown to be an effective procedure with durable results. The techniques for mitral valve repair are not completely risk-free for late failure, and the identification of factors associated with this increased risk is of clinical relevance as it permits an appropriate selection of patients for whom mitral valve surgery should be offered and by which technique. The European system for cardiac operative risk evaluation score (EuroSCORE) has been used and demonstrated worldwide to be a valid tool for the prediction of immediate postoperative outcome after coronary artery bypass surgery. There are only a few studies which examine its value in heart valve surgery. Mitral valve repair has been shown to be associated with significant improvement in terms of functional capacity, but the late quality of life in these patients has not been adequately assessed, and there is no data on the quality of life of long-term survivors. The study population consisted of two groups of patients operated on at our institution. The first group included 164 patients who underwent isolated or combined mitral valve repair for mitral valve regurgitation during the period 1993 to 2000, while the second group consisted of 207 patients who underwent mitral valve repair (164 patients) or replacement (43 patients) for isolated mitral valve regurgitation during the same time-period. The first study aimed to identify preoperative variables which may have impact on the 30-day postoperative outcome. In the second study, the long-term outcome after mitral valve repair was evaluated in order to identify the risk factors associated with late failures. The third study analyzed quality of life after valve repair and compared it to that of an age- and gender-adjusted Finnish general population. In the fourth study, the validity of EuroSCORE was tested in predicting the immediate and late outcome of patients who had undergone mitral valve repair or replacement for isolated valve regurgitation. Patient age, a history of prior cardiac surgery and NYHA functional class were independent predictors of poor outcome. A residual regurgitation grade of more than one immediately after primary repair and chronic pulmonary disease were independent predictors of mitral valve reoperation. After valve repair, quality of life was similar to the age- and sex-adjusted general Finnish population. Both additive and logistic EuroSCOREs were predictors of the immediate and late outcomes of patients after surgery for mitral valve regurgitation

Korjaa ja korota:malleja ja ideoita kerrostalojen korjaamiseen ja lisäkerrosten rakentamiseen

Tämä sähköinen julkaisu on tiivistelmä KLIKK-tutkimushankkeen painetusta julkaisusta ”Korjaa ja korota – Kerrostalojen korjaamisen ja lisäkerrosten rakentamisen ratkaisuja”, Anu Soikkeli, Jouni Koiso-Kanttila & Laura Sorri, 2015. Oulun yliopisto, Arkkitehtuurin tiedekunta. Julkaisu A 62, 205 s

Determining the subspecies composition of bean goose harvests in Finland using genetic methods

Abstract Management of harvested species is of great importance in order to maintain a sustainable population. Genetics is, however, largely neglected in management plans. Here, we analysed the genetics of the bean goose (Anser fabalis) in order to aid conservation actions for the commonly hunted but declining subspecies, the taiga bean goose (A. f. fabalis). We used mitochondrial DNA (mtDNA) and microsatellites to determine the subspecies composition of the Finnish bean goose harvest, as the hunting bag is thought to comprise two subspecies, the taiga bean goose and the tundra bean goose (A. f. rossicus). The latter subspecies has a more stable or even increasing population size. Other eastern subspecies (A. f. serrirostris, A. f. middendorffii) could additionally be part of the Finnish hunting bag. We estimated genetic diversity, genetic structure and sex-biased gene flow of the different subspecies. Most of the harvested bean geese belonged to the taiga bean goose, whereas most of the tundra bean goose harvest was found to be geographically restricted to south-eastern Finland. The mtDNA data supported strong genetic structure, while microsatellites showed much weaker structuring. This is probably due to the extreme female philopatry of the species. The taiga bean goose had lowered genetic diversity compared to other subspecies, warranting management actions. We also detected A. f. serrirostris mtDNA haplotypes and evidence of interspecific hybridization with two other Anser species

Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis

<div><h3>Context</h3><p>Studies from different geographical regions have assessed the relations between indoor dampness and mold problems and the risk of asthma, but the evidence has been inconclusive.</p> <h3>Objective</h3><p>To assess the relations between indicators of indoor dampness and mold problems and the risk of developing new asthma, and to investigate whether such relations differ according to the type of exposure.</p> <h3>Data sources</h3><p>A systematic literature search of PubMed database from 1990 through March 2012 and the reference lists of recent reviews and of relevant articles identified in our search.</p> <h3>Study selection</h3><p>Cohort/longitudinal and incident case-control studies assessing the relation between mold/dampness and new asthma were included.</p> <h3>Data extraction</h3><p>Three authors independently evaluated eligible articles and extracted relevant information using a structured form.</p> <h3>Synthesis</h3><p>Sixteen studies were included: 11 cohort and 5 incident case-control studies. The summary effect estimates (EE) based on the highest and lowest estimates for the relation between any exposure and onset of asthma were 1.50 (95% confidence interval [CI] 1.25–1.80, random-effects model, <em>Q</em>-statistic 38.74 (16), <em>P</em> = 0.001) and 1.31 (95% CI 1.09–1.58, random-effects model, <em>Q</em>-statistic 40.08 (16), <em>P</em> = 0.000), respectively. The summary effect estimates were significantly elevated for dampness (fixed-effects model: EE 1.33, 95% CI 1.12–1.56, <em>Q</em>-statistic 8.22 (9), <em>P</em> = 0.413), visible mold (random-effects model; EE 1.29, 95% CI 1.04–1.60, 30.30 (12), <em>P</em> = 0.001), and mold odor (random-effects model; EE 1.73, 95% CI 1.19–2.50, <em>Q</em>-statistics 14.85 (8), <em>P</em> = 0.038), but not for water damage (fixed-effects model; EE 1.12, 95% CI 0.98–1.27). Heterogeneity was observed in the study-specific effect estimates.</p> <h3>Conclusion</h3><p>The evidence indicates that dampness and molds in the home are determinants of developing asthma. The association of the presence of visible mold and especially mold odor to the risk of asthma points towards mold-related causal agents.</p> </div

Characteristics of studies included in the meta-analysis (n = 16).

<p>Characteristics of studies included in the meta-analysis (n = 16).</p

Forest plots.

<p><b>A.</b> Forest plot for the relation between any exposure and onset of asthma (n = 16). <b>B.</b> Forest plot for the relation between water damage and onset of asthma (n = 8). <b>C.</b> Forest plot for the relation between dampness and onset of asthma (n = 9). <b>D.</b> Forest plot for the relation between visible mold and onset of asthma (n = 12). <b>E.</b> Forest plot for the relation between mold odour and onset of asthma (n = 8).</p

Effect estimates for exposure indicators according to the hypothesized simplified causal pathway.

<p>Effect estimates for exposure indicators according to the hypothesized simplified causal pathway.</p

Diagram of the systematic search showing selection of the studies.

<p>Diagram of the systematic search showing selection of the studies.</p