Exploration into strategic groups and the pharmaceutical industry: Do strategic groups exist in the biopharmaceutical industry? : a study of the Finnish pharma cluster

Siirretty Doriast

Clinical and molecular manifestations of lower limb peripheral artery disease

Lower limb peripheral artery disease (PAD) is poorly known by the general public and even health care professionals. The manifestations of PAD are diverse depending on the prevailing cardiovascular risk factors leading to the disease. Also the outcome of patients is very different depending on the different manifestations of the disease. The end-stage of PAD, known as critical limb ischemia (CLI), is associated with very poor survival. In order to understand the heterogenic nature of PAD in depth, different molecular mechanisms of the disease in association with major cardiovascular risk factors and disease severity were investigated. The findings indicate that different cardiovascular risk factors are associated with diverse molecular pathology. This thesis work also shows that the presence of crural atherosclerosis and CLI are tightly associated with poor patient survival, and that especially CLI is associated with elevated levels of multiple circulating cytokines, which resembles a systemic inflammatory condition. The major future implications of the current findings are that CLI can no longer be referred to as a plain condition of the lower limb and effort should be put into the attenuation of the systemic inflammatory condition. Most importantly, the current findings imply that future effort should be put into studying the risk factor specific molecular mechanism leading to the disease in order to develop new specific medical therapies according to the prevailing inflammatory pathology

Glucocorticoids inhibit type I IFN beta signaling and the upregulation of CD73 in human lung

Non peer reviewe

Vuoristotauti

Matkailun lisääntyessä suomalaisten riski sairastua vuoristotautiin kasvaa. Vuoristotauti on yleinen ongelma noustaessa nopeasti yli 2 500 m:n korkeuteen. Useimmiten oireet ovat lievät ja menevät ohi muutamien päivien kuluessa. Jos oireet ja ohueen ilmanalaan sopeutumattomuus jätetään huomioimatta, voivat oireet pahentua nopeasti johtaen hengenvaaralliseen aivo- tai keuhkoödeemaan. Taudin ja oikeiden toimenpiteiden sen hoitamiseksi ja pahenemisen estämiseksi tulee olla jokaisen matkailuneuvontaa antavan lääkärin tiedossa. English summary: Mountain sickness Mountain sickness is a common problem upon climbing rapidly to an elevation above 2 500 metres. The symptoms are mostly mild, passing within a couple of days. If the symptoms and lack of adaptation to thin air are neglected, the symptoms may quickly become worse, leading to a life-threatening cerebral or pulmonary edema. Every physician providing travel counseling should be aware of this disease and the correct measures for its management

Alaraajan valtimoverenkiertohäiriön ennuste, erotusdiagnostiikka ja hoito

Alaraajan elinkelpoisuutta uhkaava verenkierron häiriö tulee tunnistaa ja potilas ohjata kiireiseen hoitoon.Maksimaalinen sydän- ja verisuonitautien sekundaariehkäisy vähentää alaraajavaltimotautia sairastavien kardiovaskulaarista kuolleisuutta ja sairastuvuutta.ABI-mittaus (ankle/brachial index) on keskeinen kardiovaskulaarisen riskin mittari ja diagnostiikan kulmakivi.</p

Crural Index and extensive atherosclerosis of crural vessels are associated with long-term cardiovascular mortality in patients with symptomatic peripheral artery disease

Background and aims: Limited data exist on the association of the anatomical distribution of atherosclerotic lesions and the extent of atherosclerosis at defined arterial segments with life expectancy. We recently presented a new classification of the extent of atherosclerosis in crural vessels and showed that Crural Index (CIx) was associated with mid-term survival of symptomatic peripheral artery disease (PAD) patients. This study evaluates the significance of the extent of crural atherosclerosis on long-term cardiovascular mortality. Methods: 887 consecutive patients with PAD, admitted for digital subtraction angiography (DSA) at Turku University Hospital Department of Vascular Surgery (Turku, Finland) between January 1st, 2009 and July 30th, 2011, were retrospectively analysed. Each crural angiographic image was graded according to CIx criteria. Aorto-iliac and femoro-popliteal arterial segments were similarly graded according to modified TASC II criteria. CIx was used as the categorical variable for the extent of atherosclerosis in crural vessels for survival analysis. Survival was also evaluated with respect to which arterial segment was most severely affected. Causes of death were provided by the Cause of Death Registry of Statistics Finland, updated on January 23rd, 2017. Results: Altogether, 408 (46%) patients died during follow-up. The majority of deaths were due to cardiovascular causes (n = 246, 60%). Cardiovascular mortality was strongly associated with a high CIx (CIx III (Hazard ratio (HR) 2.16, Confidence interval (CI) 95% 1.23-3.80, p = 0.007)) and CIx IV (HR 3.513, 95% CI 1.93-4.565, p <0.001), as compared to CIx 0. In patients having the crural segment as the most severely affected arterial segment, cardiovascular mortality was significantly increased (HR 2.321, 95% CI 1.45-3.73, p <0.001), as was overall mortality (HR 2.177, 95% CI 1.53-3.10, p <0.001). Conclusions: High Crural Index and extensive crural vessel atherosclerosis are associated with long-term cardiovascular mortality, and both may serve as useful indicators of survival among patients with symptomatic PAD. (c) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Bilateral low systolic toe pressure and toe-brachial index are associated with long-term mortality in patients with peripheral artery disease

Objective: Based on our previous reports, ipsilateral systolic toe pressure (STP) and toe-brachial index (TBI) have a strong association with midterm cardiovascular and overall mortality as well as with amputation-free survival in patients with symptomatic lower extremity peripheral artery disease (PAD). The effect of the often overlooked contralateral lower limb on patient outcome remains unknown. This study aimed to resolve the significance of contralateral STP (CL_STP) and contralateral TBI for long-term overall and cardiovascular mortality. Methods: This is a retrospective cohort study of 727 consecutive patients with symptomatic lower extremity PAD. All patients admitted to the Department of Vascular Surgery at Turku University Hospital for digital subtraction angiography between January 2009 and August 2011 and for whom STP measurements were available were recruited and observed for up to 7 years. Dates and causes of death were collected from the national cause of death registry of Statistics Finland. Results: In the study cohort, STP was Conclusions: Low STP and TBI of both contralateral and ipsilateral lower extremities are associated with high cardiovascular and overall mortality in symptomatic PAD patients. Bilaterally low STP and TBI are associated with a particularly poor prognosis.Peer reviewe

Data on association of ankle pressure and ankle brachial index of symptomatic and contralateral lower extremities with overall and cardiovascular mortality in patients with lower extremity peripheral artery disease

Data on survival curves for overall survival and freedom from cardiovascular death at different ankle brachial index (ABI) and ankle pressure (AP) are shown separately for symptomatic and contralateral lower limbs in 721 patients with lower extremity peripheral artery disease at up to 7 years follow-up. Cox regression analysis with confounding factors for ABI and AP are also shown. Dates and causes of death were collected from the Finnish national statistics registry. (C) 2018 The Authors. Published by Elsevier Inc.Peer reviewe

Data on amputation free survival of patients with lower limb peripheral artery disease classified according TASC II classification and a new crural index

Non peer reviewe