Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis

Background: Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21-2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06-2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21-12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR.Peer reviewe

Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

Objective To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Methods Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. Results Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28-1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28-2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. Conclusions RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality. Key messages Patients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG). Glucocorticoid use before CABG and duration of RA are associated with higher mortality. Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.Peer reviewe

Exploring laccase mediator systems with acidic recombinant enzymes from Obba rivulosa

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Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

Objective: To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA).Methods: Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years.Results: Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28-1.77; p p p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications.Conclusions: RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality.Key messagesPatients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG).Glucocorticoid use before CABG and duration of RA are associated with higher mortality.Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.</p

Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis

Background: Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21-2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06-2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21-12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR

Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction

Objective To evaluate whether cardiorespiratory fitness (CRF) and heart rate recovery (HRR) associate with the risk of sudden cardiac death (SCD) independently of left ventricular ejection fraction (LVEF). Methods The Finnish Cardiovascular Study is a prospective clinical study of patients referred to clinical exercise testing in 2001-2008 and follow-up until December 2013. Patients without pacemakers undergoing first maximal or submaximal exercise testing with cycle ergometer were included (n=3776). CRF in metabolic equivalents (METs) was estimated by achieving maximal work level. HRR was defined as the reduction in heart rate 1 min after maximal exertion. Adjudication of SCD was based on death certificates. LVEF was measured for clinical indications in 71.4% of the patients (n=2697). Results Population mean age was 55.7 years (SD 13.1; 61% men). 98 SCDs were recorded during a median follow-up of 9.1 years (6.9-10.7). Mean CRF and HRR were 7.7 (SD 2.9) METs and 25 (SD 12) beats/min/min. Both CRF and HRR were associated with the risk of SCD in the entire study population (HR(CRF)0.47 (0.37-0.59), p Conclusions CRF and HRR are significantly associated with the risk of SCD regardless of LVEF.Peer reviewe

Outdoor pollen concentration is not associated with exercise-induced bronchoconstriction in children

Background: Free running exercise test outdoors is an important method to diagnose asthma in children. However, the extent of how much exposure to pollens of outdoor air affects the results of the test is not known. Methods: We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 799) between January 2012 and December 2014 in Tampere University Hospital. Pollen concentrations at the time of the test were collected from the register of Biodiversity Unit of the University of Turku. We compared the frequency of exercise-induced bronchoconstriction and pollen concentrations. Results: The analyses were restricted to birch and alder pollen as high counts of grass and mugwort pollen were so infrequent. The relative change in resistance at 5 Hz after exercise or the frequency of exercise-induced bronchoconstriction were not related to alder or birch pollen concentrations over 10 grains/m3 (p = 0.125–0.398). In logistic regression analysis comparing the effects of alder or birch pollen concentrations, immunoglobulin E (IgE)-mediated alder or birch allergy and absolute humidity over 10 g/m3 only absolute humidity was independently associated with change in airway resistance (odds ratio [OR]: 0.32, confidence interval [CI]: 0.13–0.67, p: 0.006). Conclusions: In our large clinical sample, outdoor air pollen concentration was not associated with the probability of exercise-induced bronchoconstriction in free running test in children while low absolute humidity was the best predictor of airway obstruction.acceptedVersionPeer reviewe

Hyötyä taseista : Ravinnetaseiden tulkinta ympäristön ja viljelyn hyödyksi

Hyötyä taseista -hankkeessa tuotettiin typen peltotaseiden jakaumat Suomen yleisimmille viljelykasveille yhdistämällä kaikki saatavilla oleva ja systemaattisesti kerätty ravinnetasetieto peltoviljelystä. Jakaumien perusteella viljelykasvit luokiteltiin neljään eri ryhmään: (I) säilörehunurmi, (II) kaura, ohra ja tärkkelysperuna, (III) kevätvehnä ja sokerijuurikas ja (IV) kevätrypsi, syysvehnä ja ruis. Kahden ensimmäisen ryhmän mediaanitaseet olivat samansuuruiset (kivennäismailla 13–14 kg/ha käytettäessä vain väkilannoitetyppeä), mutta säilörehunurmella typpitaseet olivat huomattavasti suuremmat jakauman yläpäässä. Kasviryhmässä III mediaanitase oli vastaavasti 32 kg/ha ja ryhmässä IV kaikkein korkein, 56 kg/ha. Typpitaseet olivat lisäksi em. kasviryhmissä eloperäisillä mailla pienempiä kuin kivennäismailla. Kotieläinlantaa käytettäessä typpitaseet laskettuna liukoisen typen mukaan olivat hieman suurempia kasviryhmässä II kun taas ryhmissä III ja IV eroa ei ollut tai tase oli pienempi (säilörehunurmi). Kasviryhmien sisällä typpitaseen suuruuteen vaikutti eniten typpilannoituksen määrä. Matalimmat taseet saavutettiin, kun satotaso oli korkea ilman että oli käytetty ympäristökorvauksen enimmäislannoitusmääriä. Korkeita typpitaseita sen sijaan esiintyi, kun satotaso oli jäänyt odotettua pienemmäksi huolimatta typpilannoituksesta. Tasejakaumiin liitettiin ympäristöinformaatio potentiaalisesta vesistökuormituksesta, jota arvioitiin koeaineistojen ja mallintamisen avulla. Kasviryhmissä I ja II noin neljännes liukoisen typen taseista oli niin korkeita (ylittävät tason 60 ja 25 kg/ha), että niistä voi aiheutua keskimääräistä selvästi korkeampi typen huuhtoutumisriski. Kasviryhmässä III puolet typpitaseista ylitti riskirajan ja ryhmässä IV yli puolet. Typpitaseita tarkasteltiin myös laskemalla op-timaalisen typpilannoituksen määrää erilaisilla hintasuhteilla. Tulosten perusteella nitraattiasetus ei rajoita taloudellisesti optimaalista typpilannoitusta kevätviljoilla, mutta rajoittaa typpilannoitusta säilörehunurmen kohdalla. Ympäristökorvauksen enimmäislannoitusmäärät johtavat kevätviljoilla typpitaseisiin (16–45 kg/ha kivennäismailla), jotka ovat keskimääräistä korkeampia verrattuna em. peltolohkojen jakaumiin, mutta eivät johda peltolohkoilla havaittuihin suurimpiin typpitaseisiin. Verrattuna rajoittamattomaan taloudelliseen optimointiin, ympäristökorvaukseen sitoutuneilla maatiloilla kasvintuotannosta saatava vuotuinen katetuotto vähenee usein vain alle 10 €/ha vil-jeltäessä viljaa kivennäismailla, kun taas säilörehun tuotannossa vastaava vähenemä on lähes 50 €/ha. Tuloksia havainnollistettiin esittämällä alustavia kriteerejä typpitaseiden arviointiin ja joillekin kasveille ehdotettiin myös liukoisen typen taseiden viitearvoja mahdollista ravinnetaseohjausta varten. Ravinnetaseisiin perustuvan ohjauksen vahvuudeksi tunnistettiin satotason huomiointi, mikä voisi kannustaa peltojen perusparannuksiin.201

Pan-Eurasian Experiment (PEEX) : towards a holistic understanding of the feedbacks and interactions in the land–atmosphere–ocean–society continuum in the northern Eurasian region

Contributors: Hanna K. Lappalainen1,2, Veli-Matti Kerminen1, Tuukka Petäjä1, Theo Kurten3, Aleksander Baklanov4,5, Anatoly Shvidenko6, Jaana Bäck7, Timo Vihma2, Pavel Alekseychik1, Stephen Arnold8, Mikhail Arshinov9, Eija Asmi2, Boris Belan9, Leonid Bobylev10, Sergey Chalov11, Yafang Cheng12, Natalia Chubarova11, Gerrit de Leeuw1,2, Aijun Ding13, Sergey Dobrolyubov11, Sergei Dubtsov14, Egor Dyukarev15, Nikolai Elansky16, Kostas Eleftheriadis17, Igor Esau18, Nikolay Filatov19, Mikhail Flint20, Congbin Fu13, Olga Glezer21, Aleksander Gliko22, Martin Heimann23, Albert A. M. Holtslag24, Urmas Hõrrak25, Juha Janhunen26, Sirkku Juhola27, Leena Järvi1, Heikki Järvinen1, Anna Kanukhina28, Pavel Konstantinov11, Vladimir Kotlyakov29, Antti-Jussi Kieloaho1, Alexander S. Komarov30, Joni Kujansuu1, Ilmo Kukkonen31, Ella Kyrö1, Ari Laaksonen2, Tuomas Laurila2, Heikki Lihavainen2, Alexander Lisitzin32, Aleksander Mahura5, Alexander Makshtas33, Evgeny Mareev34, Stephany Mazon1, Dmitry Matishov35,†, Vladimir Melnikov36, Eugene Mikhailov37, Dmitri Moisseev1, Robert Nigmatulin33, Steffen M. Noe38, Anne Ojala7, Mari Pihlatie1, Olga Popovicheva39, Jukka Pumpanen40, Tatjana Regerand19, Irina Repina16, Aleksei Shcherbinin27, Vladimir Shevchenko33, Mikko Sipilä1, Andrey Skorokhod16, Dominick V. Spracklen8, Hang Su12, Dmitry A. Subetto19, Junying Sun41, Arkady Yu Terzhevik19, Yuri Timofeyev42, Yuliya Troitskaya34, Veli-Pekka Tynkkynen42, Viacheslav I. Kharuk43, Nina Zaytseva22, Jiahua Zhang44, Yrjö Viisanen2, Timo Vesala1, Pertti Hari7, Hans Christen Hansson45, Gennady G. Matvienko9, Nikolai S. Kasimov11, Huadong Guo44, Valery Bondur46, Sergej Zilitinkevich1,2,11,34, and Markku Kulmala1 1Department of Physics, University of Helsinki, 00014 Helsinki, Finland 2Finnish Meteorological Institute, Research and Development, 00101 Helsinki, Finland 3Department of Chemistry, University of Helsinki, 00014 Helsinki, Finland 4World Meteorological Organization, 1211 Genève, Switzerland 5Danish Meteorological Institute, Research and Development Department, 2100, Copenhagen 6International Institute for Applied Systems Analysis, 2361 Laxenburg, Austria 7Department of Forest Sciences, University of Helsinki, 00014 Helsinki, Finland 8Institute for Climate and Atmospheric Science, School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK 9Institute of Atmospheric Optics, Russian Academy of Sciences, Tomsk 634021, Russia 10Nansen International Environmental and Remote Sensing Center, St. Petersburg, Russia 11Lomonosov Moscow State University, Faculty of Geography, Moscow 119899, Russia 12Max Planck Institute for Chemistry, 55128 Mainz, Germany 13Institute for Climate and Global Change Research & School of Atmospheric Sciences, Nanjing University, 210023 Nanjing, China 14Institute of Chemical Kinetics & Combustion, Russian Academy of Sciences, 630090 Novosibirsk, Russia 15Institute of Monitoring of Climatic & Ecological Systems SB RAS, 634055 Tomsk, Russia 16A. M. Obukhov Institute of Atmospheric Physics, Russian Academy of Sciences, Russia 17National Centre of Scientific Research "DEMOKRITOS", Greece 18Nansen Environmental and Remote Sensing Center/Bjerknes Centre for Climate Research, 5006 Bergen, Norway 19Northern Water Problems Institute, Karelian Research Center, Russian Academy of Sciences,185003 Petrozavodsk, Russia 20P. P. Shirshov, Institute of Oceanology, Russian Academy of Sciences, Russian Academy of Sciences, 117997 Moscow, Russia 21Institute of Geography, Russian Academy of Sciences, Moscow, Russia 22Depart ment of Earth Sciences of the Russian Academy of Sciences, Russian Academy of Sciences, 119991, Moscow, Russia 23Max-Planck-Institute for Biogeochemistry, 07745 Jena, Germany 24Wageningen University, 6708 Wageningen, Nederland 25Institute of Physics, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia 26University of Helsinki, Department of World Cultures, 00014 Helsinki, Finland 27Department of Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland 28Russian State Hydrometeorological University, 195196 Saint Petersburg, Russia 29Institute of Geography, Russian Academy of Sciences, Moscow, Russia 30Institute of Physico-chemical & Biological Problems in Soil Science, Russian Academy of Sciences, 142290 Institutskaya, Russia 31University of Helsinki, Geophysics and Astronomy, 00014 Helsinki, Finland 32Shirshov Institute of Oceanology, Russian Academy of Sciences, 117997 Moscow, Russia 33Actic & Antarctic Research Institute, Russian Academy of Sciences, St. Petersburg 199397, Russia 34Department of Radiophysics, Nizhny Novgorod State University, Nizhny Novgorod, Russia 35Southern Center of Russian Academy of Sciences, Rostov on Don, Russia 36Tyumen Scientific Center, Siberian Branch, Russian Academy of Science, Russia 37Saint Petersburg State University, 7/9 Universitetskaya nab., St. Petersburg, 199034 Russia 38Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, 51014 Tartu, Estonia 39Skobeltsyn Institute of Nuclear Physics, Moscow State University, Department Microelectronics, Russia 40University of Eastern Finland, Department of Environmental Science, P.O. Box 1627, FI-70211 Kuopio, Finland 41Craduate University of Chinese Academy of Sciences, 100049 Beijing, China 42Aleksanteri Institute and Department of Social Research, 00014 University of Helsinki, Finland 43Sukachev Forest Institute, Russian Academy of Sciences, Krasnoyarsk 660036, Russia 44Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Beijing, 100094, China 45Environmental Science and Analytical Chemistry, Stockholm University, Sweden 46AEROCOSMOS Research Institute for Aerospace Monitoring, 105064, Moscow, Russia †deceased, 20 August 2015The Northern Eurasian regions and Arctic Ocean will very likely undergo substantial changes during the next decades. The arctic-boreal natural environments play a crucial role in the global climate via the albedo change, carbon sources and sinks, as well as atmospheric aerosol production via biogenic volatile organic compounds. Furthermore, it is expected that the global trade activities, demographic movement and use of natural resources will be increasing in the Arctic regions. There is a need for a novel research approach, which not only identifies and tackles the relevant multi-disciplinary research questions, but is also able to make a holistic system analysis of the expected feedbacks. In this paper, we introduce the research agenda of the Pan-Eurasian Experiment (PEEX), a multi-scale, multi-disciplinary and international program started in 2012 (https://www.atm.helsinki.fi/peex/). PEEX is setting a research approach where large-scale research topics are investigated from a system perspective and which aims to fill the key gaps in our understanding of the feedbacks and interactions between the land–atmosphere–aquatic–society continuum in the Northern Eurasian region. We introduce here the state of the art of the key topics in the PEEX research agenda and give the future prospects of the research which we see relevant in this context.Peer reviewe