Kokeellisesti aikaansaadun osittaisen unenaikaisen ylähengitystieahtauman vaikutus tcCO2-arvoihin terveellä vapaaehtoisella

Unenaikaisia hengityshäiriöitä syntyy silloin, kun ylähengitystiet ahtautuvat osittain unen aikana ja kudokset alkavat värähdellä (kuorsaus), tai kun ylähengitysteiden kudokset sulkevat nielun kokonaan (obstruktiivinen uniapnea) voimakkaan ilmavirtauksen ja siitä syntyvän alipaineen vaikutuksesta. Kuorsauksen ei ole ajateltu yleisesti olevan terveydelle haitallista. Tosin obstruktiivisen uniapnean, jonka ajatellaan kehittyvän pitkän ajan kuluessa kuorsausvärähtelyn aiheuttaman ylähengitysteiden pehmytosien veltostumisen seurauksena, tiedetään altistavan sydänja verisuonisairauksille. Tämän kuvailevan interventiotutkimuksen tavoitteena oli selvittää saadaanko keinotekoisesti tuotetulla negatiivisella hengitysilmanpaineella aiheutettua osittainen ylähengitystieahtauma ja miten elimistö reagoi osittaiseen ahtaumaan. Seurattavia parametreja olivat muun muassa ihohiilidioksidipitoisuus, hengitysyritysten voimakkuus sekä unen laatu. Tutkimukseen etsittiin kuusi vapaaehtoista tupakoimatonta tervettä yli 18-vuotiasta miestä, jotka nukkuivat yhden yön unilaboratoriossa. Unirekisteröinnissä käytettiin laajaa unipolygrafiaa. Unenaikaiset kokeet suoritettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa tutkittiin, kuinka helposti ylähengitystiet ahtautuvat passiivisen kriittisen paineen (Pcrit) määrityksen aikana. Toisessa vaiheessa tuotettiin osittainen ylähengitysteiden ahtauma negatiivisella maskipaineella, jolloin voitiin määrittää aktiivinen Pcrit. Tutkimuksen perusteella voitiin varmistaa koejärjestelyjen yleinen toimivuus sekä todeta, että kokeellisesti aiheutetun osittaisen ylähengitystieahtauman aikana tcCO2 lähtee unenaikaiselta tasanteelta ensin ylöspäin, mutta ylähengitystiepainetta laskettaessa tcCO2 palautuu ja päätyy tasanteen alapuolelle. Hengitysyritykset aluksi lisääntyivät, mutta sen jälkeen joko tasaantuivat hiilidioksidinousua seuraavassa vaiheessa tai koehenkilö havahtui unesta. Crescendo-tyyppinen hengitysyritysten nousu todettiin vain yhdellä koehenkilöllä, jonka passiivinen Pcrit pystyttiin määrittämään (–3 cmH2O). Terveellä koehenkilöllä todettiin vahva ja tehokas kyky korjata osittaiseen ylähengitysahtaumaan liittyvä ihohiilidioksidin nousu (kymmenessä interventiossa seitsemässätoista). Yhdellä koehenkilöllä korjaus ei ollut täydellinen ja välitön. Kolmessa interventiossa ennenaikainen havahtuminen esti hengitysvasteiden ilmaantumisen

The state of play in European coaching & mentoring

This report provides an overview of the main findings from the 2017 European Coaching and Mentoring Research Project, undertaken by Jonathan Passmore and Hazel Brown, in partnership with the EMCC and the wider European coaching and mentoring industry. The study was planned in 2016 and undertaken during a 12-week period, between March and May 2017. This is one of a number reports published. This Executive Report is available free of charge, along with a National Report in countries that achieved over 50 coach or mentor participants. Each National Report is published in the language chosen by of the respective national coaching community. The aim of these national reports is to deepen understanding of coaching and mentoring and to widen engagement with coaching and mentoring.peer-reviewe

Knowledge-based environments in the city: Design and urban form in the Helsinki Metropolitan Area

Knowledge-based development is of interest to cities, as it promotes economic growth and boosts dynamic urban image. Creative environments are arguably highly dependent on sociality, and they are usually located near city centres. The focus of this study is on three knowledge-based locations in the Helsinki Metropolitan Area (HMA) in Finland. The research material composes of field observation data and photographs. Results indicate that knowledge-intensive environments include several elements of good city design, for example, pedestrian-friendly street networks and green areas, but they tended to lack vibrant urban life, that is, human activity. The findings support the claim that ICT-based companies are not very dependent on the sociality of environment. As cities are spaces for individuals working, studying and visiting, attention must be paid to the urban design of these areas.</p

Inhaled Xenon Attenuates Myocardial Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest The Xe-Hypotheca Trial

Marjaana Tiainen on Xe-HYPOTHECA Study Grp -työryhmän jäsen.BACKGROUND The authors previously reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA). OBJECTIVES A pre-defined secondary objective was to assess the effect of inhaled xenon on myocardial ischemic damage in the same study population. METHODS A total of 110 comatose patients who had experienced OHCA from a cardiac cause were randomized to receive either inhaled xenon (40% end-tidal concentration) combined with hypothermia (33 degrees C) for 24 h (n = 55; xenon group) or hypothermia treatment alone (n = 55; control group). Troponin-T levels were measured at hospital admission, and at 24 h, 48 h, and 72 h post-cardiac arrest. All available cases were analyzed for troponin-T release. RESULTS Troponin-T measurements were available from 54 xenon patients and 54 control patients. The baseline characteristics did not differ significantly between the groups. After adjustments for age, sex, study site, primary coronary percutaneous intervention (PCI), and norepinephrine dose, the mean +/- SD post-arrival incremental change of the ln-transformed troponin-T at 72 h was 0.79 +/- 1.54 in the xenon group and 1.56 +/- 1.38 in the control group (adjusted mean difference -0.66; 95% confidence interval: -1.16 to -0.16; p = 0.01). The effect of xenon on the change in the troponin-T values did not differ in patients with or without PCI or in those with a diagnosis of ST-segment elevation myocardial infarction (group by PCI or ST-segment elevation myocardial infarction interaction effect; p = 0.86 and p = 0.71, respectively). CONCLUSIONS Among comatose survivors of OHCA, in comparison with hypothermia alone, inhaled xenon combined with hypothermia suggested a less severe myocardial injury as demonstrated by the significantly reduced release of troponin-T. (C) 2017 by the American College of Cardiology Foundation.Peer reviewe

Effect of Inhaled Xenon on Cardiac Function in Comatose Survivors of Out-of-Hospital Cardiac Arrest—A Substudy of the Xenon in Combination With Hypothermia After Cardiac Arrest Trial

This explorative substudy aimed at determining the effect of inhaled xenon on left ventricular function by echocardiography in comatose survivors of out-of-hospital cardiac arrest.DesignA randomized two-group single-blinded phase 2 clinical drug trial.SettingA multipurpose ICU in two university hospitals.PatientsOf the 110 randomized comatose survivors after out-of-hospital cardiac arrest with a shockable rhythm in the xenon in combination with hypothermia after cardiac arrest trial, 38 patients (24-76 yr old) with complete echocardiography were included in this study.InterventionsPatients were randomized to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours or hypothermia treatment alone. Echocardiography was performed at hospital admission and 24 ± 4 hours after hypothermia.Measurements and main resultsLeft ventricular ejection fraction, myocardial longitudinal systolic strain, and diastolic function were analyzed blinded to treatment. There were 17 xenon and 21 control patients in whom echocardiography was completed. Clinical characteristics did not differ significantly between the groups. At admission, ejection fraction was similar in xenon and control patients (39% ± 10% vs 38% ± 11%; p = 0.711) but higher in xenon than control patients after hypothermia (50% ± 10% vs 42% ± 10%; p = 0.014). Global longitudinal systolic strain was similar in xenon and control patients at admission (-9.0% ± 3.8% vs -8.1% ± 3.6%; p = 0.555) but better in xenon than control patients after hypothermia (-14.4.0% ± 4.0% vs -10.5% ± 4.0%; p = 0.006). In patients with coronary artery disease, longitudinal strain improved in the nonischemic myocardial segments in xenon patients. There were no changes in diastolic function between the groups.ConclusionsAmong comatose survivors of a cardiac cause out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia was associated with greater recovery of left ventricular systolic function in comparison with hypothermia alone