Diagnostik av kronisk kranskärlssjukdom

English summary. Kardiologi

Assessment of early treatment response by rapid cardiothoracic ultrasound in acute heart failure : Cardiac filling pressures, pulmonary congestion and mortality

Background: It is unclear how to optimally monitor acute heart failure (AHF) patients. We evaluated the timely interplay of cardiac filling pressures, brain natriuretic peptides (BNPs), lung ultrasound (LUS) and symptoms during AHF treatment. Methods: We enrolled 60 patients who had been hospitalised for AHF. Patients were examined with a rapid cardiothoracic ultrasound (CaTUS) protocol, combining LUS and focused echocardiographic evaluation of cardiac filling pressures (i.e. medial E/e' and inferior vena cava index [IVCi]). CaTUS was done at 0, 12, 24 and 48 hours (3 hours) and on the day of discharge, alongside clinical evaluation and laboratory samples. Patients free of congestion (Blines or pleural fluid) on LUS at discharge were categorised as responders, whereas the rest were categorised as non-responders. Improvement in congestion parameters was evaluated separately in these groups. The effect of congestion parameters on prognosis was also analysed. Results: Responders experienced a significantly larger decline in E/e' (2.58 vs. 0.38, p=0.037) and dyspnoea visual analogue scale (1-10) score (7.68 vs. 3.57, p=0.007) during the first 12 hours of treatment, while IVCi and BNPs declined later without no such rapid initial decline. Among patients experiencing a >3 U decline in E/e' during the first 12 hours of treatment, 18/21 were to become responders (p Conclusion: E/e' seemed like the most useful congestion parameter for monitoring early treatment response, predicting prognostically beneficial resolution of pulmonary congestion.Peer reviewe

Manipulating overstory density and mineral soil exposure for optimal natural regeneration of Scots pine

In northern boreal region the growth of forests is slow, and yield and profit are low, which is why low refor-estation costs are important for profitable forestry. If natural regeneration is successful, expensive artificial forest regeneration (planting or direct seeding) can be avoided. In this study, we look at the impact of overstory density and site preparation on natural regeneration and seedling growth of Scots pine. Study stands were established in different parts of Northern Finland and in each stand following treatments: 50, 150 and 250 trees ha-1 or unthinned control, where the stand density was >= 250 trees ha-1, were randomly allocated to experimental plots. In addition, site preparation (disc trenching, 4000-5000 m ha-1) was carried out on two experimental plots in which tree density was either 50 or 150 trees ha-1. In the experimental stands seedling number, age and growth were monitored for 11 years. Monitoring revealed that the number of seedlings increased with decreasing tree density. Average seedling height growth was very low or even non-existent in the unthinned control and in the densest (250 trees ha-1) treatment, but increased when the density of trees decreased. The highest seedling number and the highest growth were achieved when the tree density was 50 trees ha-1 and the soil was prepared to expose mineral soil. Achieving e.g. 2000 seedlings ha-1, would need about 40% exposition of mineral soil. The required low tree density implies that not only seed supply from seed trees and site preparation is important for regeneration success in northern boreal Scots pine forests but also the reduction of competition by mature trees

A Subspace Method for Dynamical Estimation of Evoked Potentials

It is a challenge in evoked potential (EP) analysis to incorporate prior physiological knowledge for estimation. In this paper, we address the problem of single-channel trial-to-trial EP characteristics estimation. Prior information about phase-locked properties of the EPs is assesed by means of estimated signal subspace and eigenvalue decomposition. Then for those situations that dynamic fluctuations from stimulus-to-stimulus could be expected, prior information can be exploited by means of state-space modeling and recursive Bayesian mean square estimation methods (Kalman filtering and smoothing). We demonstrate that a few dominant eigenvectors of the data correlation matrix are able to model trend-like changes of some component of the EPs, and that Kalman smoother algorithm is to be preferred in terms of better tracking capabilities and mean square error reduction. We also demonstrate the effect of strong artifacts, particularly eye blinks, on the quality of the signal subspace and EP estimates by means of independent component analysis applied as a prepossessing step on the multichannel measurements

Levodopa-Induced Changes in Electromyographic Patterns in Patients with Advanced Parkinson's Disease

Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.Peer reviewe

Signal features of surface electromyography in advanced Parkinson's disease during different settings of deep brain stimulation

Objective: Electromyography (EMG) and acceleration (ACC) measurements are potential methods for quantifying efficacy of deep brain stimulation (DBS) treatment in Parkinson's disease (PD). The treatment efficacy depends on the settings of DBS parameters (pulse amplitude, frequency and width). This study quantified, if EMG and ACC signal features differ between different DBS settings and if DBS effect is unequal between different muscles. Methods: EMGs were measured from biceps brachii (BB) and tibialis anterior (TA) muscles of 13 PD patients. ACCs were measured from wrists. Measurements were performed during seven different settings of DBS and analyzed using methods based on spectral analysis, signal morphology and nonlinear dynamics. Results: The results showed significant within-subject differences in the EMG signal kurtosis, correlation dimension, recurrence rate and EMG-ACC coherence between different DBS settings for BB but not for TA muscles. Correlations between EMG feature values and clinical rest tremor and rigidity scores were weak but significant. Conclusions: Surface EMG features differed between different DBS settings and DBS effect was unequal between upper and lower limb muscles. Significance: EMG changes pointed to previously defined optimal settings in most of patients, which should be quantified even more deeply in the upcoming studies. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Venäjän metsäpolitiikka ja suomalainen metsäteollisuus

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