Millaisia kansainvälistymispalveluita suomalaiset kasvuyritykset haluavat? : Case Kasvun Roihu Oy

Opinnäytetyön tavoitteena oli selvittää, kuinka tyytyväisiä suomalaiset kasvuyritykset ovat kansainvälistymispalveluiden tarjoamaan ja millaisille palveluille kasvuyritykset näkevät tulevaisuudessa yhä enemmän tarvetta. Tutkimuksen toimeksiantajana toimi Kasvun Roihu Oy. Tutkimus oli ajankohtainen, koska suomalaiset yritykset ovat olleet jo pitkään tyytymättömiä julkisiin kansainvälistymispalveluihin ja niiden tarjoajiin. Opinnäytetyöstä teki ajankohtaisen myös se, että suomalaisten pienten ja keskisuurien yritysten vienti on lievässä kasvussa. Lähtökohtana tutkimukselle oli toimeksiantajan tarve saada tietoa Kasvu Open finalistiyritysten kansainvälistymisen haasteista ja siitä, millaisia kansainvälitymispalveluita yritykset tarvitsevat tulevaisuudessa yhä enemmän. Tätä tietoa ei oltu ennen tutkittu systemaattisesti. Tutkmuksessa nousi esille, että Kasvu Openin finalistiyritykset ovat erittäin kasvuhakuisia, mutta myös ennen kaikkea erittäin kansainvälistymishakuisia. Tutkimustulosten perusteella yritykset eivät ole riitävän tietoisia kansainvälistymispalveluiden tarjoomasta. Palveluihin toivotaan tulevaisuudessa yhä enemmän laadukkuutta, syvyyttä ja konkretiaa. Etenkin rahoituspalveluihin ja verkkottumispalveluihin toivotaan uudistuksia, sekä oikeita ammattilaisia oikeille osa-alueille

Measurement of epithelial electrical passive parameters and its application to study gastric defence against acid and ulcerogenic agents

The aim of this study was to develop a reliable method for measuring epithelial membrane and shunt resistances. This was accomplished by improving the intraepithelial two dimensional cable analysis by using multiple electrodes simultaneously and by sequentially applying the intraepithelial current through different electrodes thus taking advantage of their spatial relationship. The improvement achieved with this novel method is its excellent temporal resolution; changes in the membrane and shunt pathway resistances can be typically measured in 9-20 seconds. The actual measurement time depends on the target tissue, number of electrodes, electrode noise and distance configuration. This technique was applied to investigate the effects of luminal acid on membrane resistances of Necturus gastric (antral) mucosa. The main finding was that luminal acid closes sodium selective, amiloride blockable channels on the apical cell membrane probably by protonating 1-2 amino acid residues of the channel molecule itself. These findings suggest that the epithelium can generate a protective barrier against the luminal acidic offence by closing its apical cell membrane channels. Besides direct protection against H+ influx, another possible advantage gained by closure of the Na+-selective channels in the apical cell membrane is the maintenance of a sufficient transmembrane Na+ gradient for Na+-dependent acid equivalent transport processes across the basolateral cell membrane. The method was also used to elucidate the effects of luminal ethanol on the epithelial membrane resistances of Necturus gastric mucosa. Surprisingly, the first effects were seen on the basolateral cell membrane, not on the apical cell membrane or on the shunt pathway, as would have been expected. With ion substitution and channel blocker experiments, it was deduced that potassium selective channels on the basolateral cell membrane were opened by luminal ethanol exposure. This opening of potassium channels decreased cell volume. The present data indicate that opening of basolateral K+ channels with resultant epithelial cell shrinkage are among the earliest functional perturbations that might precede and underlie ethanol induced gastric mucosal injury. The subsequent opening of apical Na+ selective channels with consequent increase in intracellular Na+ load after more prolonged ethanol exposure suggests further functional deterioration of the epithelium. On the other hand, the profound changes in intraepithelial resistances provoked by stronger ethanol insult (i.e. collapse of Ra, decrease in Rs and closing of the gap-junctions as judged from the increased Rx) are more compatible with a structural damage of the epithelium and probably reflect emerging disruption of the surface epithelium.reviewe

The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus

Purpose: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. Method: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge. Functional outcome was assessed with Glasgow Outcome Scale (GOS1-3 for poor outcome, GOS > 3 for good outcome) and also defined as condition relative to baseline (worse-than baseline vs. baseline). Univariate and multivariate regression models were used to analyze the relations between delays and outcome. Delay cut-offs predicting outcome were determined using ROC-Curves. Results: In univariate analysis long onset-to-tertiary-hospital time (p = 0.034) was a significant risk factor for worse-than-baseline condition. Long delays in onset-to-diagnosis (p = 0.032), onset-to-second-stage medication (p = 0.023), onset-to-consciousness (p = 0.027) and long total-anesthesia-time (0 = 0.043) were risk factors for low GOS score (1-3). Short delay in onset-to-initial-treatment (p = 0.047), long onset-to-anesthesia (p = 0.003) and onset-to-consciousness (p = 0.008) times were risk factors for in hospital mortality. Multivariate analysis showed no significant factors. Cut-offs for increased risk of poor outcome were onset-to-diagnosis 2.4 h (p = 0.011), onset-to-second stage-medication 2.5 h (p = 0.001), onset-to-consciousness 41.5 h (p = 0.009) times and total-anesthesia time 45.5 h (p = 0.003). The delay over 2.1 h in onset-to-tertiary-hospital time increased the risk of worse than-baseline condition (p = 0.028). Conclusions: GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Optimal Perioperative Fluid Therapy Associates with Fewer Complications After Pancreaticoduodenectomy

Background Optimal fluid management in pancreaticoduodenectomy patients remains contested. We aimed to examine the association between perioperative fluid administration and postoperative complications. Methods We studied 168 pancreaticoduodenectomy patients operated in 2015 (n = 93) or 2017 (n = 75) at Helsinki University Hospital. In 2015, patients received intraoperative fluids following a goal-directed approach and, in 2017, according to anesthesiologist's clinical practice (conventional fluid management). We analyzed the differences in perioperative fluid administration between the groups, specifically examining the occurrence of severe complications (Clavien-Dindo >= III), pancreatic fistulas, cardiovascular complications, and the length of hospital stay. Results The goal-directed group received more intraoperative fluids than the conventional fluid management group (12.0 ml/kg/h vs. 8.3 ml/kg/h, p < 0.001). Urine output (770 ml vs. 575 ml, p = 0.004) and intraoperative fluid balance (9.4 ml/kg/h vs. 6.3 ml/kg/h, p < 0.001) were higher in the goal-directed group than in the conventional fluid management group. Severe surgical complications (19.4% vs. 38.7%, p = 0.009) as well as clinically relevant pancreatic fistulas (1.1% vs. 10.7%, p = 0.011) occurred more frequently in patients receiving conventional fluid management. Moreover, the conventional fluid management group experienced longer hospital stays (9.0 vs. 11.5 days, p = 0.02). Lower intraoperative fluid volume accompanying conventional fluid management was associated with a higher risk of severe postoperative complications compared with higher volume in the goal-directed group (odds ratio 2.58 (95% confidence interval 1.04-6.42), p = 0.041). Conclusions The goal-directed group experienced severe complications less frequently. Our findings indicate that optimizing the intraoperative fluid administration benefits patients, while adopting a too-restrictive approach represents an inferior choice.Peer reviewe

Do Changes in Perioperative and Postoperative Treatment Protocol Influence the Frequency of Pulmonary Complications? A Retrospective Analysis of Four Different Bariatric Groups

The current understanding of prophylaxis of pulmonary complications in bariatric surgery is weak. Purpose: The aim of this study was to observe how changes in perioperative and postoperative treatments affect the incidence of pulmonary complications in bariatric patients. Materials: This is a retrospective clinical study of 400 consecutive bariatric patients. The patients, who either underwent a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into four subgroups with different approaches to perioperative treatment. Methods: The first group (patients 0-100) was recovered in the intensive care unit with minimal mobilization (ICU). They had a urinary catheter and a drain. The second group (patients 101-200) was similar to the first group, but the patients used a continuous positive airway pressure (CPAP) device intermittently (ICU-CPAP). The third group (patients 201-300) was recovered on a normal ward without a urinary catheter or a drain and used a CPAP device (ward-slow). The fourth group (patients 301-400) walked to the operating theater and was mobilized in the recovery room during the first 2 h after the operation (ward-fast). CPAP was also used. Primary endpoints were pulmonary complications, pneumonia, and infection, non-ultra descriptus (NUD). Results: The number of pulmonary complications among the groups was significantly different. A long operation time increased the risk for infection (p <0.001 95 % CI from 2.02 to 6.59 %). Conclusions: Operation time increases the risk for pulmonary complications. Changes in perioperative care toward the ERAS protocol may have a positive effect on the number of pulmonary complications.Peer reviewe

Changes in CRP and CA19-9 during Preoperative Oncological Therapy Predict Postoperative Survival in Pancreatic Ductal Adenocarcinoma

Introduction: Tumor and systemic inflammatory markers predict survival. This retrospective study aimed to explore the changes in CRP, CA19-9, and other routine laboratory tests during preoperative oncological therapy as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). Methods: Between 2000 and 2016, 68 borderline resectable PDAC patients received preoperative oncological therapy and underwent subsequent surgery at Helsinki University Hospital, Finland. We investigated changes in CRP, CA19-9, CEA, albumin, leukocytes, bilirubin, and platelets and examined the impact on survival. Results: In the multivariate analysis, CRP remaining at >= 3 mg/L after preoperative oncological therapy predicted a poorer postoperative outcome when compared to CRP decreasing to or remaining at 90% during preoperative treatment predicted a favorable postoperative outcome (HR 0.297, 95% CI: 0.124-0.708, p = 0.006). In the Kaplan-Meier analysis, the median survival for patients with CRP remaining at = 3 mg/L (42 months vs. 24 months, p = 0.001). Patients with a CA19-9 decrease >90% or level normalization (toPeer reviewe

Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients : a cross-sectional study

Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02-36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6-127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN.Peer reviewe

Mucin 16 and kallikrein 13 as potential prognostic factors in colon cancer: Results of an oncological 92-multiplex immunoassay

Colon cancer represents one of the most common cancers in the world. Despite improved treatment, mortality remains high. In order to improve the assessment of prognosis for colon cancer patients, identifying new prognostic markers remains necessary. We analyzed preoperative serum samples from 148 colon cancer patients surgically treated at Helsinki University Hospital from 1998 through 2002 using a multiplex proximity extension assay (Oncology II panel, Olink Bioscience, Uppsala, Sweden), a panel constituting 92 immunological and oncological markers. We performed univariate and multivariate analyses on these patients and calculated the disease-specific survival among patients using the log-rank test for Kaplan?Meier estimates. In the univariate survival analysis of 92 biomarkers, 26 resulted in p?Peer reviewe

Delays and Factors Related to Cessation of Generalized Convulsive Status Epilepticus

Peer reviewe

Predictors of mortality at one year after generalized convulsive status epilepticus

Background: Status epilepticus (SE) is a life-threatening neurologic emergency, which requires prompt medical treatment. Little is known of the long-term survival of SE. The aim of this study was to investigate which factors influence 90 days and 1-year mortality after SE. Materials and methods: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with generalized convulsive SE (GCSE) in Helsinki University Central Hospital (HUCH) emergency department (ED) over 2 years. We defined specific factors including patient demographics, GCSE characteristics, treatment, complications, delays in treatment, and outcome at hospital discharge and determined their relation to 90 days and 1-year mortality after GCSE by using logistic regression models. Survival analyses at 1 year after GCSE were performed with Cox proportional hazards regression analysis. Results: In-hospital mortality was 7.1%. Mortality rate was 14.3% at 90 days and 24.3% at 1 year after GCSE. In the univariate logistic regression analysis, Status Epilepticus Severity Score > 4 (STESS) (ODDS = 7.30, p = 0.012), worse-than-baseline condition at hospital discharge (ODDS = 3.5, p = 0.006), long delays in attaining seizure freedom (ODDS = 2.2, p = 0.041), and consciousness (ODDS = 3.4, p = 0.014) were risk factors for mortality at 90 days whereas epilepsy (ODDS = 0.2, p = 0.014) and Glasgow Outcome Scale (GOS) > 3 at hospital discharge (ODDS = 0.05, p = 0.006) were protective factors. Risk factors for mortality at 1 year were STESS >4 (ODDS = 5.1, p = 0.028), use of vasopressors (ODDS = 8.2, p = 0.049), and worse-than-baseline condition at discharge (ODDS = 7.8, p = 0.010) while GOS >3 (ODDS = 0.2, p = 0.005) was protective. The univariate survival analysis at 1 year confirmed the significant findings regarding parameters STESS >4 (Hazard ratio (HR) = 4.1, p = 0.009), worse-than-baseline condition (HR = 6.2, p = 0.015), GOS >3 (HR = 0.2, p = 0.004) at hospital discharge and epilepsy (HR = 0.4, p = 0.044). Additionally, diagnostic delay over 6 h (HR = 3.8, p = 0.022) and Complication Burden Index (CBI) as an ordinal variable (0-2, 3-6, >6) (HR = 2.7, p = 0.027) were predictive for mortality. In the multivariate survival analysis, STESS > 4 ( HR = 5.1, p = 0.007), CBI (HR = 3.2, p = 0.025, ordinal variable), diagnostic delay over 6 h (HR = 7.2, p = 0.003), and worse-than-baseline condition at hospital discharge (HR = 5.8, p = 0.027) were all independent risk factors for mortality at 1 year. Conclusions: Severe form of SE, delayed recognition of GCSE, high number of complications during treatment period, and poor condition at hospital discharge are all independent predictors of long-term mortality. Most of these factors are also associated with mortality at 90 days, though at that point, delays in treatment seem to have a greater impact on prognosis than at 1 year. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures (c) 2019 Elsevier Inc. All rights reserved.Peer reviewe