Arteriakanyylin käyttö ja hoito

Opinnäytetyön tarkoituksena oli tuottaa ajantasaista näyttöön perustuvaa opetusmateriaalia Laurea ammattikorkeakoulun sairaanhoitajaopiskelijoille arteriakanyloidun potilaan hoidosta ja kanyylin käytöstä komplikaatioiden välttämiseksi. Opinnäytetyöni tavoitteena on tuottaa kirjallisuuskatsaus sairaanhoitajaopiskelijoille oppimateriaaliksi arteriakanyloidun potilaan hoitotyöstä komplikaatioiden välttämiseksi sekä siihen perustuva Testaa osaamisesi -tehtävä. Opinnäytetyö toteutettiin kirjallisuuskatsauksena. Aineisto kerättiin enimmäkseen ulkomaisista tietokannoista (Medic, Cinahl, JBI, PubMed ja Google Scholar). Opinnäytetyön keskeiset käsitteet ovat arteriakanyylin asettaminen, hoito, näytteenotto, arteriakanyylin poisto ja arteriakanyloinnin komplikaatiot. Tutkimuskysymyksen avulla oli tarkoitus selvittää, miten hoidetaan arteriakanyloitua potilasta komplikaatioiden välttämiseksi. Aineistoksi valikoitui kahdeksan ulkomaista ja yksi kotimainen tutkimusartikkeli, jotka on julkaistu vuosina 2014-2019. Aineisto analysoitiin deduktiivisen sisällönanalyysin avulla. Kirjallisuuskatsauksen tulosten perusteella arteriakanyloinnin komplikaatioita on dokumentoitu vähän ja valtimon kanylointi lyhyellä aikavälillä on turvallinen toimenpide. On tutkittu myös vaihtoehtoisia non-invasiivisia menetelmiä arteriakanyloinnin korvaamiseksi, mutta niissä tarvitaan vielä lisää tutkimuksia. Tämän opinnäytetyön tulosten perusteella voidaan todeta, että aseptiikka, koulutus ja arteriakanyylin paikan valinta ovat avainasemassa komplikaatioiden välttämisessä. Kaiken kaikkiaan on kuitenkin dokumentoitu alhainen määrä valtimolinjan laittoon liittyviä komplikaatioita. Vaihtoehtoisia non-invasiivisia menetelmiä jatkuvaan verenpaineen mittauksen tulee vielä tutkia enemmän

Changes in Iron Measures over Menopause and Associations with Insulin Resistance

Abstract Objectives: No longitudinal studies have examined how iron measures change over menopause. Our objectives were to examine iron measures in individual women at premenopause and at postmenopause and, secondarily, to determine if any changes contributed to insulin resistance. Methods: In a subset of participants (n=70) in a longitudinal study of menopause, we measured ferritin, transferrin, and soluble transferrin receptor (sTfR) once in the premenopause and once in the postmenopause. We also examined associations between menopausal status and change in iron markers after adjustment for age at menopause, race/ethnicity, and waist circumference. In linear regression models, we examined associations between premenopause iron measures and changes in iron markers over menopause with homeostasis model assessment of insulin resistance (HOMA-IR) changes over menopause, before and after adjustment for age at menopause, race/ethnicity, changes in waist circumference, C-reactive protein (CRP), and sex hormone-binding globulin (SHBG) levels. Results: Women had lower ferritin (p<0.01), higher sTfR:ferritin levels (p<0.01), lower HOMA-IR (p=0.022), and lower glucose (p=0.05) in premenopause compared to postmenopause. After adjustment, lower premenopausal iron levels (sTfR:ferritin levels ?=11.0, 95% confidence interval [CI] 0.017-22.0) and larger increases in iron over menopause (changes in sTfR:ferritin ?=13.6, 95% CI 0.93-26.3) were associated with larger increases in HOMA-IR. Conclusions: From premenopause to postmenopause, women on average have increases in measures of iron stores. Women who had the greatest changes in iron over menopause (lower measures of premenopausal iron and greater increases in iron measures over the menopause) had the strongest associations between changes in iron and changes in insulin resistance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98464/1/jwh%2E2012%2E3549.pd

Cell cycle regulators p27 and pRb in lymphomas – correlation with histology and proliferative activity

The cell cycle is a complex event in which multiple regulator-proteins participate. The G 1/S checkpoint of the cell cycle is controlled by pRb protein, which functions in its hypophosphorylated form as a negative regulator of growth. p27 (Kip1), a member of CIP/KIP family of cyclin inhibitory proteins, participates in inhibition of forming complexes that allow pRb to phosphorylate and lead the cell into mitosis. The expression of these important cell cycle regulator proteins was studied in a total of 96 non-Hodgkin’s lymphoma (NHL) samples, which were classified according to the REAL classification. The expression of p27, pRb and the cell proliferation marker Ki-67 (MIB-1) was evaluated in lymphomas using immunohistochemistry. This study showed that there were coordinate changes in the expression of p27 and pRb in NHL. When compared to low-grade lymphomas, high-grade lymphomas showed significantly reduced expression of p27 and inversely pRb expression was increased (P < 0.001). Increase in expression of Ki-67 was parallel with pRb expression, and was mainly seen in cells that lacked p27 expression (P < 0.0001). This study suggests that changes in the control of the cell cycle closely relate to the pathobiology of NHL. © 2000 Cancer Research Campaig

Flow-Mediated Vasodilation Is Not Attenuated in Hypertensive Pregnancies Despite Biochemical Signs of Inflammation

Background. Our objective was to evaluate endothelial function and markers of inflammation during and after pregnancy in normal pregnancies compared to pregnancies complicated with hypertension or preeclampsia (PE). Methods and Results. We measured endothelium-dependent brachial artery flow-mediated vasodilation (FMD) and high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α) in 32 women with normal pregnancy and in 28 women whose pregnancy was complicated with hypertensive disorder in the second half of pregnancy and minimum 3-month postpartum. Enhancement of endothelial function was greater in hypertensive than normal pregnancies, the mean FMD% being 11.0% versus 8.8% during pregnancy (P = 0.194) and 8.0% versus 7.9% postpartum (P = 0.978). Concentrations of markers of inflammation were markedly increased in pregnant hypertensive group compared to those after delivery (hsCRP 4.5 versus 0.80 mg/L, P = 0.023, IL-6 2.1 versus 1.2 pg/mL, P = 0.006; TNF-α 1.9 versus 1.5 pg/mL, P = 0.030). There were no statistically significant associations between the markers of inflammation and FMD. Conclusions. Brachial artery FMD was not attenuated in the third trimester hypertensive pregnancies compared to normal pregnancies, whereas circulating concentrations of hsCRP and IL-6 and TNF-α reacted to hypertensive complications

Serum soluble T-H cell activity markers and high-sensitivity C-reactive protein in multiple-trigger wheezers

Peer reviewe

Success Rate and Technical Quality of Home Polysomnography With Self-Applicable Electrode Set in Subjects With Possible Sleep Bruxism

Using sleep laboratory polysomnography (PSG) is restricted for the diagnosis of only the most severe sleep disorders due to its low availability and high cost. Home PSG is more affordable, but applying conventional electroencephalography (EEG) electrodes increases its overall complexity and lowers the availability. Simple, self-administered single-channel EEG monitors on the other hand suffer from poor reliability. In this study, we aimed to quantify the reliability of self-administrated home PSG recordings conducted with a newly designed ambulatory electrode set (AES) that enables multichannel EEG, electrooculography, electromyography, and electrocardiography recordings. We assessed the sleep study success rate and technical quality of the recordings performed in subjects with possible sleep bruxism (SB). Thirty-two females and five males aged 39.6 +/- 11.6 years (mean +/- SD) with self-reported SB were recruited in the study. Self-administrated home PSG recordings with two AES designs were conducted (n = 19 and 21). The technical quality of the recordings was graded based on the proportion of interpretable data. Technical failure rate for AES (both designs) was 5% and SB was scorable for 96.9% of all recorded data. Only one recording failed due to mistakes in self-applying the AES. We found that the proportion of good quality self-administrated EEG recordings is significantly higher when multiple channels are used compared to using a single channel. Sleep study success rates and proportion of recordings with high quality interpretable data from EEG channels of AES were comparable to that of conventional home PSG. Self-applicable AES has potential to become a reliable tool for widely available home PSG.Peer reviewe

Self-Applied Electrode Set Provides a Clinically Feasible Solution Enabling EEG Recording in Home Sleep Apnea Testing

Home sleep apnea testing (HSAT) without electroencephalography (EEG) recording is increasingly used as an alternative to in-laboratory polysomnography for the diagnosis of obstructive sleep apnea (OSA). However, without EEG, electrooculography (EOG), and chin electromyography (EMG) recordings, the OSA severity may be significantly underestimated. Although several ambulatory EEG systems have been recently introduced, no patient-applied systems including EEG, EOG, and chin EMG suitable for home polysomnography are currently in clinical use. We have recently developed and pre-clinically tested a self-applied ambulatory electrode set (AES), consisting of frontal EEG, EOG, and EMG, in subjects with possible sleep bruxism. Now, in this clinical feasibility study, we investigated the signal scorability and usability of the AES as a self-administered sleep assessment approach supplementing the conventional HSAT device. We also investigated how the diagnostic parameters and OSA severity changed when utilizing the AES. Thirty-eight patients (61 % male, 25-78 years) with a clinical suspicion of OSA conducted a single-night, self-administered HSAT with a portable polysomnography device (Nox A1, Nox Medical, Reykjavik, Iceland) supplemented with AES. Only one AES recording failed. The use of AES signals in data analysis significantly affected the median apnea-hypopnea index (AHI), increasing it from 9.4 to 12.7 events/h (p < 0.001) compared to the conventional HSAT. Also, in eight patients, the OSA severity class changed to one class worse. Perceived ease of use was well in line with that previously found among healthy volunteers. These results suggest that the AES provides an easy, clinically feasible solution to record EEG as a part of conventional HSAT.Peer reviewe