Phosphatidylethanol in lipoproteins as a regulator of vascular endothelial growth factor in vascular wall cells

Abstract Phosphatidylethanol (PEth) is an abnormal phospholipid formed only in the presence of ethanol. Ethanol causes changes in the concentration and composition of plasma lipoproteins and it also influences the enzymes and transfer proteins that modify lipoproteins in plasma. PEth might be one of these changes brought on by ethanol in the circulation. The present study was designed to investigate whether qualitative changes in high density lipoprotein (HDL) phospholipids caused by ethanol can mediate the beneficial effects of alcohol on atherosclerosis, and to investigate the transfer of PEth between lipoproteins and the effects of PEth on the charge of lipoprotein particles. PEth was shown to be transferred from low density lipoproteins (LDL) to HDL particles mainly by transfer proteins other than cholesteryl ester transfer protein (CETP). The transfer of PEth between lipoproteins enables the redistribution of PEth between lipoproteins in plasma. The results of this study provide evidence that PEth in HDL particles stimulates the vascular endothelial growth factor (VEGF) secretion from vascular wall cells. The increase in the secretion was mediated through protein kinase C (PKC) and mitogen-activated protein kinase (MAPK) signalling pathways. PEth-containing HDL particles were able to increase the VEGF secretion in rats in vivo. Similar effects were also observed when rats were given HDL particles isolated from the plasma of alcoholics. The PEth-induced change in the electrical charge of lipoproteins may affect the binding of lipoproteins to their receptors and binding proteins. The effects of PEth on the secretion of VEGF from the endothelial cells were shown to be mediated through HDL receptor. The changes in HDL particles caused by phosphatidylethanol may modify the metabolism of lipoproteins and lipid-mediated signalling pathways regulating VEGF in vascular wall cells

Finländare vandrar i skogen, norrmän på berget, men vad gör svenskar?:en studie av bilder på Instagram-kontona ourfinland, visitsweden och visitnorway

Syftet med denna pro gradu-avhandling var att analysera bilder som har publicerats på Finlands, Sveriges och Norges officiella Instagram-konton ourfinland, visitsweden och visitnorway. Materialet bestod av 453 bilder varav 108 har publicerats av Visit Finland, 148 av Visit Sweden och 197 av Visit Norways. Bilder har publicerats under tidsperioden 1.1.–15.6.2015. En bild har tagits från Instagram-kontot ourfinland från den 6 december 2015. De valda metoderna var bildanalys, innehållsanalys, semiotisk analys samt analysering av ländernas image. Med hjälp av denotationer skapade kategorier som är människor, djur och fåglar, skogar, vattenområden, berg och fjäll, städer och byar, landsort, byggnader och boende, mat, växter och blommor, båtar och andra trafikmedel, föremål, vägar och stigar samt naturfenomen. Bilder kunde höra till fler än en kategori. Jag analyserade hur dessa bilder påverkar landets imagebyggande. Med hjälp av konnotationer och symboler analyserade jag de kulturella angelägenheterna i bilder. Jag analyserade också hur distans och attityder, som makt och engagemang, uppfylls i bilder. För att får mer omfattande uppfattning om de bilder som publiceras på Instagram av dessa organisationer ställde jag frågor till dem via e-post. I teoridelen diskuterades de viktigaste teorierna gällande turism, organisationskommunikation, bildanalys, semiotiskanalys samt image. De viktigaste resultaten i analysen var att bilder på de analyserade Instagram-konton har likheter och olikheter. De publicerade bilderna är därtill mångsidiga, och de påverkar Finlands, Sveriges och Norges image. De flesta bilderna med människor, på alla tre Instagram-konton, har fotograferats från öga mot öga-perspektiv och är distanserade. De har fotograferats bakifrån och är erbjudande. Med hjälp av Finlands bilder får man en sådan uppfattning att Finland är ett vackert, rent samt orört land och resemål. I Finland får man vara i fred och slappna av. Man kan syssla med olika sommar- och vinteraktiviteter där. Natur och skogar är nära den finska kulturen och finländare vandrar mycket i skogar. De badar bastu och tillbringar tid i sommarstugor. Uppfattningen om Sverige är mycket likadan med Finlands. Det finns skogar i Sverige och naturen är nära svenskar och deras kultur. Svenskar tycker om att baka och äta olika bakelser. Också Sverige är ett vackert, rent och orört land. I Sverige har man inte bråttom till någonstans och där kan man slappna av samt vara i lugn och ro. Svenskar promenerar i olika platser. Stämningen i Sverige och i bilder är mycket lugn. I Norge däremot finns enorma och imponerade berg och fjäll. Norge ligger vid hav och fiskeri är en viktig näring där. Man kan syssla med flera olika aktiviteter i Norge. Norrmän ser inte ut att vara lika lugna som svenskar. De vandrar på berg till skillnad för Finlands skogar. I Norge kan man uppleva dess majestetiska natur och lanskap samt syssla med olika saker.Tutkimukseni tarkoituksena oli analysoida kuvia, jotka on julkaistu Suomen, Ruotsin ja Norjan virallisilla Instagram -tileillä ourfinland, visitsweden ja visitnorway. Tutkimuksen materiaali koostuu 453 kuvasta, joista 108 on julkaistu Visit Finlandin toimesta, 148 Visit Swedenin toimesta sekä 197 Visit Norwayn toimesta. Kuvat on julkaistu aikavälillä 1.1.–15.6.2016. Yksi kuvista on julkaistu Visit Finlandin Instagram -tilillä 6.12.2016. Analyysissa käytetyt metodit olivat kuva-analyysi, sisällönanalyysi sekä niiden avulla tapahtuva kyseisten maiden imagon analysoiminen. Denotaatioiden avulla loin kategoriat ihmiset, eläimet ja linnut, metsät, vesistöt, vuoret ja tunturit, kaupungit ja kylät, maalaismaisemat, rakennukset ja asuminen, ruoka, kasvit ja kukat, veneet ja muut kulkuneuvot, esineet, tiet ja polut sekä luonnonilmiöt. Kuvat voivat kuulua useampaan kuin yhteen kategoriaan. Analysoin myös kuvien vaikutusta kyseisten maiden imagon rakentumiseen. Konnotaatioiden sekä symbolien avulla tutkin kulttuurisia asioita, joita kuvissa esiintyy. Lisäksi analysoin etäisyyden ja asenteiden ilmenemistä kuvissa. Saadakseni laajemman käsityksen näiden organisaatioiden Instagram -tileillä julkaisemista kuvissa, esitin organisaatioille kysymyksiä sähköpostilla. Teoriaosiossa keskusteltiin tärkeimmistä teorioista koskien matkailua, organisaatioviestintää, kuva-analyysia, semioottista analyysia sekä imagoa. Tutkimuksen tärkeimmät tulokset ovat, että kyseisillä Instagram -tileillä julkaistavissa kuvissa on eroavaisuuksia sekä yhtäläisyyksiä. Kuvat ovat lisäksi monipuolisia, ja ne vaikuttavat kyseisten maiden imagoon. Suurin osa kuvista, jotka kuvaavat ihmisiä, on kuvattu silmästä silmään -kuvakulmasta ja ovat etäisiä. Kuvat on kuvattu takaa päin siten, että kuvien ihmisillä on selkä katsojaan päin. Suurin osa kuvista on tarjoavia. Kuvien avulla muodostuva imago on Suomen kohdalla sellainen, että Suomi on kaunis, puhdas ja koskematon maa sekä matkakohde. Suomessa voi olla rauhassa ja rentoutua. Siellä on myös mahdollista harrastaa erilaisia talvi- sekä kesäaktiviteetteja. Luonto on lähellä suomalaisia ja suomalaiset vaeltavat paljon metsissä. Suomessa saunotaan ja vietetään aikaa mökillä. Kuvien avulla muodostuva käsitys Ruotsista matkakohteena on melko samanlainen kuin Suomesta muodostuva käsitys. Myös Ruotsissa on metsiä ja luonto on lähellä ruotsalaisia sekä heidän kulttuuriaan. Ruotsalaiset pitävät erilaisista leivoksista. Myös Ruotsi on kaunis, puhdas ja koskematon maa. Ihmisillä ei ole kiire minnekään ja he voivat rentoutua kaikessa rauhassa. Ruotsalaiset pitävät kävelemisestä erilaisissa paikoissa. Ruotsin kuvien tunnelma on hyvin rauhallinen. Norjassa puolestaan on valtavia sekä vaikuttavia vuoria ja tuntureita. Norja on meren rannalla ja kalastus kuuluu olennaisesti sen elinkeinoon. Norjalaiset eivät vaikuta yhtä rauhallisilta kuin ruotsalaiset. Suomalaiset vaeltavat metsissä kun taas norjalaiset vaeltavat vuorilla. Majesteettinen luoto sekä maisemat ovat yksi Norjan matkailukokemuksista. Siellä on myös paljon harrastusmahdollisuuksia

The negative impact of interface design, customizability, inefficiency, malfunctions, and information retrieval on user experience:a national usability survey of ICU clinical information systems in Finland

Abstract Introduction: Clinical information systems (CISs) used in intensive care units (ICU) integrate large amounts of patient data every minute, and from multiple systems and devices. Intensive care requires efficient use of information technology to acquire, synchronize, integrate, and analyze data in order to make quick decisions and implement interventions in a timely manner. Objectives: To identify factors affecting poor user experience (UX) of CISs used in ICUs in Finland. Methods: Data from national Electronic Health Record (EHR) and user experience survey was undertaken in 2017. Those, who used the ICU CIS on a daily or weekly basis were asked supplementary questions and, therefore, comprise a subset of the responses reported in this article. Results: On a 4–10 scale (i.e., “Fail” to “Excellent”), the mean ‘grade’ for the principally used ICU CIS was 6.9 (SD 1.3) points. Of the respondents, 119 (57%) were categorized as having good UX. The factors identified as affecting poor UX of the ICU CISs related to poor interface design (OR 7.8; 95% CIs 12.5–24.1; p = 0.001), insufficient customizability (OR 7.2; 95% CIs 1.7–30.6; p = 0.008), the inefficiency of performing routine tasks (OR 4.3; 95% CIs 1.0–18.2; p = 0.044), malfunctions (OR 3.5; 95% CIs 1.2–9.6; p = 0.019), and difficulties in information retrieval (OR 3.0; 95% CIs 1.0–8.8; p = 0.044). The most commonly reported usability problems with the main EHR system and ICU CISs were also identified. Conclusions: Overall satisfaction with the principally used ICU CIS was moderate. However, the overall grades varied significantly. Poor interface design, insufficient customizability, inefficiency, malfunctions, and difficulties in information retrieval all affect poor UX

Causes of nutrition deficit during immediate postoperative period after free flap surgery for cancer of the head and neck

Abstract Purpose: The aim of the present of study was to examine nutrition deficit during the immediate postoperative in-hospital period following free flap surgery for cancer of the head and neck (HNC). Underfeeding and malnutrition are known to be associated with impaired short- and long-time recovery after major surgery. Methods: This single-center retrospective cohort study included 218 HNC patients who underwent free flap surgery in Oulu University Hospital, Finland between the years 2008 and 2018. Nutrition delivery methods, the adequacy of nutrition and complication rates were evaluated during the first 10 postoperative days. Results: A total of 131 (60.1%) patients reached nutritional adequacy of 60% of calculated individual demand during the follow-up period. According to multivariate analysis, nutrition inadequacy was associated with higher ideal body weight (OR 1.11 [1.04–1.20]), whereas adequate nutrition was associated with higher number of days with oral food intake (OR 0.79 [0.67–0.93]). Conclusion: Inadequate nutrition is common after HNC free flap surgery. The present results suggest that more adequate nutrition delivery might be obtained by the early initiation of oral food intake and close monitoring of nutrition support

Prehospital and hospital delays for stroke patients treated with thrombolysis:a retrospective study from mixed rural-urban area in Northern Finland

Abstract Background: Thrombolysis improves stroke outcome, but efficacy of the treatment is limited by time. Therefore, recognition of stroke symptoms by dispatch centres and by emergency medical services (EMS) is crucial, as is minimization of pre-hospital delays. We investigated the pre-hospital delays in patients with stroke treated with thrombolysis and compared the delays between rural and urban patients. Methods: Patients that had received thrombolysis at Oulu University Hospital (OUH) between 1 January 2013 and 31 December 2015 were identified. Patients were divided into urban and rural based on the site of the EMS mission. Pre-hospital charts and medical records were reviewed. Onset-to-dispatch, dispatch-to-arrival of EMS, on-scene, transport and door-to-needle times were studied. Results: Three hundred one stroke patients were treated with thrombolysis at OUH, and 232 of them were included in the study. Positive Face Arm Speech Test (FAST) findings, priority dispatch code and transport code were associated with shorter transport delays. The priority dispatch was not used in 12.5% of stroke patients treated with thrombolysis. The rural patients had a four minutes longer dispatch-to-arrival delay and 50 (34, 74) minutes longer transport time. The door-to-needle time was 8 (5, 14) minutes shorter in rural patients than in urban patients. Conclusions: Positive FAST findings and the use of priority dispatch code and priority transport code were associated with shorter transport delays. There is room for improvement in door-to-needle time and in stroke recognition by the dispatch centre and EMS providers. For the rural population, helicopter transportation could reduce the long pre-hospital time

Medical complications and outcome after endovascular therapy for acute ischemic stroke

Abstract Aim: Endovascular therapy (EVT) in acute stroke is an effective but invasive treatment which is frequently followed by various complications. The aim of the present study was to examine the rate of medical complications and other adverse events following EVT. Methods: Retrospective single-center study of 380 consecutive stroke patients who received EVT between the years 2015–2019. Results: A total of 234 (61.6%) patients had at least one recorded medical complication. The most common complication was pneumonia in 154 (40.5%) patients, followed by acute cardiac insufficiency in 134 (35.3%), and myocardial infarction in 22 (5.8%) patients. In multivariate analysis, the need for general anesthesia (OR 3.8 (1.9–7.7)), Charlson Comorbidity Index >3 (OR 1.3 (1.1–1.5)), male gender (1.9 (1.1–1.3)) and high National Institutes of Health Stroke Scale (NIHSS) score at admission (1.1 (1.0–1.2)) were associated with medical complications. Conclusion: Medical complications are common among unselected stroke patients undergoing EVT. Both comorbidity and stroke severity have an influence on medical complications. Early recognition of complications is essential, because vast majority of patients encountering medical complications have a poor short-term outcome

Nutrition delivery after emergency laparotomy in surgical ward:a retrospective cohort study

Abstract Purpose: Adequate nutrition after major abdominal surgery is associated with less postoperative complications and shorter hospital length of stay (LOS) after elective procedures, but there is a lack of studies focusing on the adequacy of nutrition after emergency laparotomies (EL). The aim of the present study was to investigate nutrition adequacy after EL in surgical ward. Methods: The data from 405 adult patients who had undergone emergency laparotomy in Oulu University Hospital (OUH) between years 2015 and 2017 were analyzed retrospectively. Nutrition delivery and complications during first 10 days after the operation were evaluated. Results: There was a total of 218 (53.8%) patients who were able to reach cumulative 80% nutrition adequacy during the first 10 postoperative days. Patients with adequate nutrition (> 80% of calculated calories) met the nutritional goals by the second postoperative day, whereas patients with low nutrition delivery (< 80% of calculated calories) increased their caloric intake during the first 5 postoperative days without reaching the 80% level. In multivariate analysis, postoperative ileus [4.31 (2.15–8.62), P < 0.001], loss of appetite [3.59 (2.18–5.93), P < 0.001] and higher individual energy demand [1.004 (1.003–1.006), P = 0.001] were associated with not reaching the 80% nutrition adequacy. Conclusions: Inadequate nutrition delivery is common during the immediate postoperative period after EL. Oral nutrition is the most efficient way to commence nutrition in this patient group in surgical ward. Nutritional support should be closely monitored for those patients unable to eat

Outcomes in patients requiring intensive care unit (ICU) admission after emergency laparotomy:a retrospective study

Abstract Purpose: Outcomes after emergency laparotomy (EL) are poor. These patients are often admitted to an intensive care unit (ICU). This study explored outcomes in patients who were admitted to an ICU within 48 h after EL. Materials and Methods: This retrospective single-center registry study included all patients over 16 years of age that underwent an EL and were admitted to an ICU within 48 h after surgery in Oulu University Hospital, Finland between January 2005 and May 2015. Survival was followed until the end of 2019. Results: We included 525 patients. Hospital mortality was 13.3%, 30-day mortality was 17.3%, 90-day mortality was 24.2%, 1-year mortality was 33.0%, and 5-year mortality was 59.4%. Survivors were younger (57 [45–70] years) than the non-survivors (73 [62–80] years; p < .001). According to the Cox regression model, death during the follow-up was associated with age, APACHE II-score, lower postoperative CRP levels and platelet count of the first postoperative day, and the admission from the post-anesthesia care unit (PACU) to the ICU instead of direct ICU admission. Conclusion: Age, high APACHE II-score, low CRP and platelet count, and admission from the PACU to the ICU associated with mortality after EL in patients admitted to an ICU within 48 h after EL

Causes of death for intensive care survivors with and without acute kidney injury in 5‐year follow‐up

Abstract Background: Data on the causes of death and long‐term mortality of intensive care unit‐treated hospital survivors with acute kidney injury (AKI) are limited. The goal of this study was to analyze the causes of death among critically ill patients during a 5‐year follow‐up. Methods: In this predetermined sub‐study of a prospective, observational, multi‐center cohort from the FINNAKI study, we analyzed 2436 patients who were discharged from the hospital. Statistics Finland provided the follow‐up data and causes of death. Results: During the follow‐up, 765 (31%) patients died, of whom 295 (39%) had AKI and 73 (9.5%) had received renal replacement therapy. More than half of the deaths in both the non‐AKI and AKI groups occurred after the 1 year follow‐up (58% vs. 54%, respectively). The three most common causes of death in AKI were cardiovascular diseases (36%), malignancies (21%), and neurological diseases (11%). In early deaths (<90 days) cardiovascular causes were more prevalent in AKI patients compared to non‐AKI (38% vs 25%, P = .037.) In six cases (0.8%), the main cause of death was kidney disease, out of which five were in the AKI group. In patients with cardiovascular causes, the median time to death was shorter in AKI patients compared to non‐AKI patients (508 vs 816 days, P = .018). Conclusions: Cardiovascular causes and malignancies account for more than half of the causes of death in patients who had suffered AKI, while death from kidney disease after AKI is rare. Early cardiovascular deaths are more prevalent in AKI compared to non‐AKI patients