Pariterapian vaikuttavuus parisuhteen vuorovaikutukseen

Tiivistelmä. Tutkielman yhtenä tavoitteena on selvittää, millä tavalla pariterapia voi vaikuttaa parisuhteen vuorovaikutukseen. Tutkimuksen toisena tavoitteena on selvittää, onko eri pariterapiasuuntauksilla erilaista vaikuttavuutta parisuhteen vuorovaikutukseen. Tarve tutkimukselle tulee siitä, että erilaisten terapioiden vaikuttavuudesta käydään jatkuvaa keskustelua. Keskustelua käydään liittyen siihen, kuinka paljon terapioilla on vaikutusta ja mitkä tekijät määrittävät vaikuttavuutta. Tutkielman tutkimuskysymys on: Miten pariterapian eri suuntaukset vaikuttavat parisuhteen vuorovaikutukseen? Tutkielman teossa käytetty menetelmä on integroiva kirjallisuuskatsaus. Tutkielman teon aikana on syvennytty erityisesti kansainvälisiin kvantitatiivisin menetelmin toteutettuihin tutkimuksiin. Tutkimukset ovat käsitelleet pariterapian vaikuttavuutta parisuhteeseen ja parisuhteen vuorovaikutukseen. Sen lisäksi on perehdytty muuhun alan asiantuntijoiden, kuten psykoterapeuttien, tuottamaan kirjallisuuteen. Kirjallisuuskatsauksen tuloksena voidaan todeta, että pariterapialla on paljon vaikutusmahdollisuuksia pariterapian vuorovaikutukseen. Suurempi merkitys vaikuttavuuteen on asiakkaaseen liittyvillä tekijöillä, kuten asiakkaan odotuksilla ja sitoutuneisuudella, kuin terapiasuuntauksilla itsessään. On kuitenkin tutkittu, että esimerkiksi tunnekeskeisen pariterapian muita suuremmasta vaikuttavuudesta on näyttöä. Pariterapeutit voivat hyödyntää tutkielman tuloksia omassa työssään huomioimalla asiakkaaseen liittyviä vaikutustekijöitä paremmin. Tutkielman lähdeaineistoa voidaan pitää luotettavana, mutta lisätutkimusta kaivataan. Erityisesti kognitiivis-analyyttisesta pariterapiasta ja integroivista pariterapioista olisi hyvä saada lisää monipuolista tutkimusta, jotta näidenkin suuntausten erityispiirteitä voisiin hyödyntää paremmin

The year in cardiology: imaging. The year in cardiology 2019.

No abstract available

Estimation of optimal number of gates in dual gated ¹⁸F-FDG cardiac PET

Gating of positron emission tomography images has been shown to reduce the motion effects, especially when imaging small targets, such as coronary plaques. However, the selection of optimal number of gates for gating remains a challenge. Selecting too high number of gates results in a loss of signal-to-noise ratio, while too low number of gates does remove only part of the motion. Here, we introduce a respiratory-cardiac motion model to determine the optimal number of respiratory and cardiac gates. We evaluate the model using a realistic heart phantom and data from 12 cardiac patients (47–77 years, 64.5 on average). To demonstrate the benefits of our model, we compared it with an existing respiratory model. Based on our study, the optimal number of gates was determined to be five respiratory and four cardiac gates in the phantom and patient studies. In the phantom study, the diameter of the most active hot spot was reduced by 24% in the dual gated images compared to non-gated images. In the patient study, the thickness of myocardium wall was reduced on average by 21%. In conclusion, the motion model can be used for estimating the optimal number of respiratory and cardiac gates for dual gating

Performance of the American Heart Association/American College of Cardiology Guideline-Recommended Pretest Probability Model for the Diagnosis of Obstructive Coronary Artery Disease

BACKGROUND: Substantial differences exist between different guideline‐recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was performed to study the performance of the 2021 American Heart Association/American College of Cardiology (AHA/ACC) guideline‐recommended PTP (AHA/ACC‐PTP) model in assessing the likelihood of obstructive CAD compared with previously proposed models. METHODS AND RESULTS: Symptomatic patients (N=50 561) referred for coronary computed tomography angiography were included. The reference standard was invasive coronary angiography with optional fractional flow reserve measurements. The AHA/ACC‐PTP values based on sex and age were calculated and compared with the 2019 European Society of Cardiology guideline PTP values based on sex, age, and symptoms as well as the risk factor–weighted clinical likelihood values based on sex, age, symptoms, and risk factors. The AHA/ACC‐PTP maximum values overestimated by a factor of 2.6 the actual prevalence of CAD. Compared with the AHA/ACC‐PTP model (area under the receiver‐operating curve, 71.5 [95% CI, 70.7–72.2]), inclusion of typicality of symptoms in the European Society of Cardiology guideline PTP improved discrimination of CAD (area under the receiver‐operating curve, 75.5 [95% CI, 74.7–76.3]). Inclusion of both symptoms and risk factors in the risk factor–weighted clinical likelihood model further improved discrimination (area under the receiver‐operating curve, 77.7 [95% CI, 77.0–78.5]). The proportion of patients classified as very low PTP was lower using the AHA/ACC‐PTP (5%) compared with the European Society of Cardiology guideline PTP (19%) and the risk factor–weighted clinical likelihood (49%) models. CONCLUSIONS: The new AHA/ACC‐PTP model overestimates the prevalence of obstructive CAD substantially if type of symptoms and risk factors are not taken into account. Inclusion of both symptoms and risk factors improves model performance and identifies more patients with very low likelihood of CAD in whom further testing can be deferred

Muscle Free Fatty-Acid Uptake Associates to Mechanical Efficiency During Exercise in Humans

Intrinsic factors related to muscle metabolism may explain the differences in mechanical efficiency (ME) during exercise. Therefore, this study aimed to investigate the relationship between muscle metabolism and ME. Totally 17 healthy recreationally active male participants were recruited and divided into efficient (EF; n = 8) and inefficient (IE; n = 9) groups, which were matched for age (mean +/- SD 24 +/- 2 vs. 23 +/- 2 years), BMI (23 +/- 1 vs. 23 +/- 2 kg m(-2)), physical activity levels (3.4 +/- 1.0 vs. 4.1 +/- 1.0 sessions/week), and (V)over dotO(2)peak (53 +/- 3 vs. 52 +/- 3 mL kg(-1) min(-1)), respectively, but differed for ME at 45% of (V)over dotO(2)peak intensity during submaximal bicycle ergometer test (EF 20.5 +/- 3.5 vs. IE 15.4 +/- 0.8%, P < 0.001). Using positron emission tomography, muscle blood flow (BF) and uptakes of oxygen (m(V)over dotO(2)), fatty acids (FAU) and glucose (GU) were measured during dynamic submaximal knee-extension exercise. Workload-normalized BF (EF 35 +/- 14 vs. IE 34 +/- 11 mL 100 g(-1) min(-1), P = 0.896), m(V)over dotO(2) (EF 4.1 +/- 1.2 vs. IE 3.9 +/- 1.2 mL 100 g(-1) min(-1), P = 0.808), and GU (EF 3.1 +/- 1.8 vs. IE 2.6 +/- 2.3 m mol 100 g(-1) min(-1), P = 0.641) as well as the delivery of oxygen, glucose, and FAU, as well as respiratory quotient were not different between the groups. However, FAU was significantly higher in EF than IE (3.1 +/- 1.7 vs. 1.7 +/- 0.6 m mol 100 g(-1) min(-1), P = 0.047) and it also correlated with ME (r = 0.56, P = 0.024) in the entire study group. EF group also demonstrated higher use of plasma FAU than IE, but no differences in use of plasma glucose and intramuscular energy sources were observed between the groups. These findings suggest that the effective use of plasma FAU is an important determinant of ME during exercise

Circulating N-terminal brain natriuretic peptide and cardiac function in response to acute systemic hypoxia in healthy humans

Background: As it remains unclear whether hypoxia of cardiomyocytes could trigger the release of brain natriuretic peptide (BNP) in humans, we investigated whether breathing normobaric hypoxic gas mixture increases the circulating NT-proBNP in healthy male subjects.Methods: Ten healthy young men (age 29 ± 5 yrs, BMI 24.7 ± 2.8 kg/m2) breathed normobaric hypoxic gas mixture (11% O2/89% N2) for one hour. Venous blood samples were obtained immediately before, during, and 2 and 24 hours after hypoxic exposure. Cardiac function and flow velocity profile in the middle left anterior descending coronary artery (LAD) were measured by Doppler echocardiography.Results: Arterial oxygen saturation decreased steadily from baseline value of 99 ± 1% after the initiation hypoxia challenge and reached steady-state level of 73 ± 6% within 20-30 minutes. Cardiac output increased from 6.0 ± 1.2 to 8.1 ± 1.6 L/min and ejection fraction from 67 ± 4% to 75 ± 6% (both p < 0.001). Peak diastolic flow velocity in the LAD increased from 0.16 ± 0.04 to 0.28 ± 0.07 m/s, while its diameter remained unchanged. In the whole study group, NT-proBNP was similar to baseline (60 ± 32 pmol/ml) at all time points. However, at 24 h, concentration of NT-proBNP was higher (34 ± 18%) in five subjects and lower (17 ± 17%), p = 0.002 between the groups) in f

The “beauty in the beast”—the multiple uses of Priestia megaterium in biotechnology

Over 30 years, the Gram-positive bacterium Priestia megaterium (previously known as Bacillus megaterium) was systematically developed for biotechnological applications ranging from the production of small molecules like vitamin B12, over polymers like polyhydroxybutyrate (PHB) up to the in vivo and in vitro synthesis of multiple proteins and finally whole-cell applications. Here we describe the use of the natural vitamin B12 (cobalamin) producer P. megaterium for the elucidation of the biosynthetic pathway and the subsequent systematic knowledge-based development for production purposes. The formation of PHB, a natural product of P. megaterium and potential petro-plastic substitute, is covered and discussed. Further important biotechnological characteristics of P. megaterium for recombinant protein production including high protein secretion capacity and simple cultivation on value-added carbon sources are outlined. This includes the advanced system with almost 30 commercially available expression vectors for the intracellular and extracellular production of recombinant proteins at the g/L scale. We also revealed a novel P. megaterium transcription-translation system as a complementary and versatile biotechnological tool kit. As an impressive biotechnology application, the formation of various cytochrome P450 is also critically highlighted. Finally, whole cellular applications in plant protection are completing the overall picture of P. megaterium as a versatile giant cell factory

Increased B-Type Natriuretic Peptide Concentration Is Associated with Reduced Coronary Vasoreactivity in Patients with Dilated Cardiomyopathy but Not in Healthy Young Subjects

Background/Aims. Natriuretic peptides are associated with the cardiovascular disease risk under a range of different circumstances. However, less is known about whether this association is found also in young healthy subjects. Methods. 9 patients with dilated cardiomyopathy and 26 healthy young subjects were studied. The myocardial blood flow measurements were performed basally and during adenosine infusion using PET. Results. S-proBNP concentrations were significantly higher (2153 ± 1964 versus 28 ± 17 ng/L, P = .000002) and adenosine-stimulated flow lower (1.6 ± 0.8 versus 3.6 ± 1.1 mL·g−1·min−1, P = .00001) in patients with dilated cardiomyopathy when compared to healthy subjects. S-proBNP concentration was inversely associated with adenosine stimulated flow in patients with dilated cardiomyopathy (r = −0.75, P = .019) but not in healthy subjects (r = −0.06, P = .84). Conclusions. Natriuretic peptides are inversely associated with coronary vasoreactivity in patients with dilated cardiomyopathy but not in healthy young subjects. Since reduced coronary vasoreactivity seems to be one of the earliest abnormalities in the development of coronary artery disease, this might indicate that natriuretic peptides are not predictor of cardiovascular disease risk in healthy young subjects