Ultrasound-Navigated MANTA™ deployment after Removal of Extracorporeal Membrane Oxygenation Cannula

The case provided suggests that ultrasound-navigated MANTA™ works well closing percutaneously the peripheral arterial ECMO cannulation site. Ultrasound use during ECMO decannulation can further diminish the possible device related technical failures (toggle or collagen protrusion through the vessel wall, toggle stacking into calcifications, or delivery failure of the collagen pad) leading to bleeding and vascular complications. Further studies are needed on this topic.Peer reviewe

Ryhmäyttäminen kouluterveydenhuollon voimavarana

Opinnäytetyön tarkoituksena oli kuvata oppilaiden ryhmäyttämistä kouluterveydenhuollon voimavarana. Projekti tehtiin yhteistyössä Tikkurilan lukion kanssa. Tikkurilan lukion 1. luokkalaisille pidettiin yhteensä kuusi toiminnallista ryhmäyttämispäivää 26.8.–11.9.2008 välisenä aikana. Päiviin osallistuivat kaikki Tikkurilan lukion 1. luokkalaiset, yhteensä noin 356 opiskelijaa. Opiskelijat osallistuivat päiviin tutor-ryhmissään. Päivän aikana yhteen kokoontui kaksi tutor-ryhmää (noin 60 opiskelijaa). Projektin tavoitteena oli antaa opiskelijoille mahdollisuus tutustua toisiinsa sekä Tikkurilan lukion erityistyöntekijöihin (kuraattori, terveydenhoitaja, psykologi ja erityisopettaja). Näin pyrittiin mahdollisten opiskeluun liittyvien ongelmien ennaltaehkäisyyn, kuten syrjäytymisen ja opintojen keskeyttämisen vähentämiseen. Ihmisjoukon muodostuminen ryhmäksi on lähtökohta tavoitteelliselle ryhmätyölle. Koululuokka on yksi tärkeimmistä ryhmistä lapsen kasvun kannalta. Kouluterveyskyselyiden mukaan erilaiset ongelmat, kuten koulukiusaaminen, väkivalta ja turvattomuus ovat lisääntyneet nuorten keskuudessa. Useat lukion 1. ja 2. luokkalaiset tuntevat, että opiskeluilmapiirissä on ongelmia. Lukion oppilaat kuuluvat kouluterveydenhuollon piiriin, jota on pyritty kehittämään 2000-luvulla lasten ja nuorten muuttuneita tarpeita vastaavaksi. Etenkin ennaltaehkäisevää toimintaa on pyritty lisäämään. Kouluterveydenhuollon tehtävänä on kouluyhteisön hyvinvoinnin ja terveyden edistäminen. Ryhmäyttämispäivät perustuivat yhdessä toimimiseen. Päivät aloitettiin lämmittelyleikein, joista siirryttiin draaman avulla tehtäviin harjoitteisiin. Päivän ohjelma koostui leikeistä ja draamaharjoitteista, joihin opiskelijoiden oli helppo osallistua. Yhdessä toimimisella pyrittiin kiinteyttämään ryhmää. Opiskelijoilta sekä yhteistyökumppaneilta saatu palaute toiminnallisista ryhmäyttämispäivistä oli positiivista. Enemmistö oppilaista koki päivän hyödylliseksi. Erityistyöntekijöiden palautteen mukaan heidän osallistumisensa toiminnallisiin päiviin helpottaa opiskelijaa ottamaan yhteyttä heihin mahdollisissa ongelmatilanteissa. Ryhmäyttämistoimintaa voidaan pitää kouluterveydenhuollon voimavarana ennaltaehkäistäessä kouluterveydenhuollon piiriin kuuluvia ongelmia. Voimavaralla tarkoitetaan resursseja ja mahdollisuuksia. Ajallisesti yksi päivä ei riitä ryhmäyttämiseen, mutta parhaimmillaan se antaa hyvät lähtökohdat ryhmän muotoutumiselle.Grouping as a resource in school health care The aim of the thesis was to describe the grouping process as a resource in school health care. Project was carried out in co-operation with Tikkurila upper secondary school. During the time period of 26.8. - 11.9.2008 total of six active grouping days were organized to the first graders of Tikkurila upper secondary school. All 356 students attended the grouping days along with their tutor groups (two separate tutor groups per day, approximately 60 students). The project aimed at enabling students to get acquainted with other student colleagues and special employees at Tikkurila upper secondary school (curator, school nurse, psychologist, special needs teacher). This type of familiarization strived for prevention of any possible study related problems like displacement as well as reduction of drop-outs. The formation of groups is the starting point for a successful and target-oriented group work. School class is one of the most important groups in a child's growth process. According to school health care inquiries various problems like teasing, violence and insecurity have increased among adolescents. Many of the first and second graders also experienced the studying atmosphere to be problematic. Students of upper secondary school fall into domain of school health care which has been under development to meet the changing needs of children and youth of the 21st century better. The effort has been made in order to increase preventive work in particular. One of the main ideas of school health care is the progression of wellbeing and health. The grouping days consisted of acting together and through those activities the students were given the opportunity to get to know each other. The days started with warm up games after which drama supported trainings took place and, finally, the days were assembled by ending games. The feedback on the grouping days from both the students and the partners in co-operation was positive. The students felt that the day and the time spent together were useful and pleasant. Special employees thought that their presence might make it easier for the students to seek support from them in potential future problems. Grouping operations can be considered as a resource in school health care when preventing problems that fall into domain of school health care. Recourse means possibilities and opportunities. One day alone is not sufficient in creating group spirit but it prepares the grounds for to proceed on that path also in actual school environment.Yksi opinnäytetyöntekijöistä on Miisa Heinsaari (ei mahtunut tekijäkenttään)

Ultrasound-Guided Versus Conventional MANTA Vascular Closure Device Deployment After Transcatheter Aortic Valve Implantation

Publisher Copyright: © 2022 The AuthorsDespite the development of device technology and operators' experience, access site vascular complications (VCs) remain one of the major concerns after transcatheter aortic valve implantation (TAVI). MANTA (Teleflex, Wayne, Pennsylvania) is a large-bore vascular closure device (VCD) with promising incidence of VC. Previously, we demonstrated that the ultrasound-guided MANTA (US-MANTA) technique further improved the outcomes compared with conventional MANTA (C-MANTA) without ultrasound guidance. The present study was established to prove the effectiveness of the technique in a larger population. In this study, we included 1,150 patients (335 patients with C-MANTA and 815 with US-MANTA) who received MANTA after TAVI from April 2017 to September 2021. The primary endpoint was MANTA-related VC. Overall VC, VCD failure, and bleeding complications were also assessed based on the Valve Academic Research Consortium 3 criteria. MANTA-related VC occurred in 12.5% in the C-MANTA group and 6.8% in the US-MANTA group (p = 0.001). VCD failure rate were 7.5% and 3.9%, respectively (p = 0.012). Valve Academic Research Consortium 3 major and minor VC were more frequent in C-MANTA group (major: 7.8% vs 4.4%, p = 0.023; minor: 8.1% vs 4.4%, p = 0.022). Multivariate analysis revealed US-MANTA as the negative predictor of MANTA-related VC (odds ratio 0.57, 95% confidence interval 0.36 to 0.89, p = 0.013). However, subgroup analysis showed the efficacy of the US-MANTA technique was limited to the patients without severely calcified puncture site (Pinteraction = 0.048). In conclusion, the US-MANTA technique was an effective strategy to reduce VC after transfemoral TAVI compared with C-MANTA. (c) 2022 The Authors. Published by Elsevier Inc.Peer reviewe

The Efficacy of the Ultrasound-Navigated MANTA Deployment following Transfemoral Transcatheter Aortic Valve Replacement

Non peer reviewe

Local C-Reactive Protein Expression in Obliterative Lesions and the Bronchial Wall in Posttransplant Obliterative Bronchiolitis

The local immunoreactivity of C-reactive protein (CRP) was studied in a heterotopic porcine model of posttranplant obliterative bronchiolitis (OB). Bronchial allografts and control autografts were examined serially 2–28 days after subcutaneous transplantation. The autografts stayed patent. In the allografts, proliferation of inflammatory cells (P < .0001) and fibroblasts (P = .02) resulted in occlusion of the bronchial lumens (P < .01). Influx of CD4+ (P < .001) and CD8+ (P < .0001) cells demonstrated allograft immune response. CRP positivity simultaneously increased in the bronchial walls (P < .01), in macrophages, myofibroblasts, and endothelial cells. Local CRP was predictive of features characteristic of OB (R = 0.456–0.879, P < .05−P < .0001). Early obliterative lesions also showed CRP positivity, but not mature, collagen-rich obliterative plugs (P < .05). During OB development, CRP is localized in inflammatory cells, myofibroblasts and endothelial cells probably as a part of the local inflammatory response

Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery

Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988–1999. Of the patients, 76 (0.9%) developed sudden postoperative hemodynamic collapse resulting in subsequent emergency reopening of the median sternotomy and open cardiac massage. Further emergency reoperation could be performed in 62 (82%) whereas 14 patients died prior to reoperation and a further 21 did not survive the reoperation or died a few days later. All 35 (46%) patients who did not survive were subjected to medico-legal autopsy combined with postmortem cast angiography. By combining clinical data with autopsy and angiography data, various types of graft complications were observed in 27 (36%, 1.3 per patient) of the 76 patients with hemodynamic collapse. There were no significant differences in the frequency (33 vs. 40%) or number of complicated grafts per patient (1.2 vs. 1.4) between those who survived reoperation and who did not. Autopsy detected 25 major and minor findings not diagnosed clinically. Postmortem cast angiography visualized 2 graft twists not possible to detect by autopsy dissection only. Surgical graft complications were the most frequent single cause for sudden postoperative hemodynamic collapse in CABG patients leading to a fatal outcome in almost half of the cases. Postmortem angiography improved the accuracy of autopsy diagnostics of graft complications

Epitranscriptomics of Ischemic Heart Disease—The IHD-EPITRAN Study Design and Objectives

Epitranscriptomic modifications in RNA can dramatically alter the way our genetic code is deciphered. Cells utilize these modifications not only to maintain physiological processes, but also to respond to extracellular cues and various stressors. Most often, adenosine residues in RNA are targeted, and result in modifications including methylation and deamination. Such modified residues as N-6-methyl-adenosine (m6A) and inosine, respectively, have been associated with cardiovascular diseases, and contribute to disease pathologies. The Ischemic Heart Disease Epitranscriptomics and Biomarkers (IHD-EPITRAN) study aims to provide a more comprehensive understanding to their nature and role in cardiovascular pathology. The study hypothesis is that pathological features of IHD are mirrored in the blood epitranscriptome. The IHD-EPITRAN study focuses on m6A and A-to-I modifications of RNA. Patients are recruited from four cohorts: (I) patients with IHD and myocardial infarction undergoing urgent revascularization; (II) patients with stable IHD undergoing coronary artery bypass grafting; (III) controls without coronary obstructions undergoing valve replacement due to aortic stenosis and (IV) controls with healthy coronaries verified by computed tomography. The abundance and distribution of m6A and A-to-I modifications in blood RNA are charted by quantitative and qualitative methods. Selected other modified nucleosides as well as IHD candidate protein and metabolic biomarkers are measured for reference. The results of the IHD-EPITRAN study can be expected to enable identification of epitranscriptomic IHD biomarker candidates and potential drug targets

Epitranscriptomics of Ischemic Heart Disease - The IHD-EPITRAN Study Design and Objectives

Epitranscriptomic modifications in RNA can dramatically alter the way our genetic code is deciphered. Cells utilize these modifications not only to maintain physiological processes, but also to respond to extracellular cues and various stressors. Most often, adenosine residues in RNA are targeted, and result in modifications including methylation and deamination. Such modified residues as N-6-methyl-adenosine (m(6)A) and inosine, respectively, have been associated with cardiovascular diseases, and contribute to disease pathologies. The Ischemic Heart Disease Epitranscriptomics and Biomarkers (IHD-EPITRAN) study aims to provide a more comprehensive understanding to their nature and role in cardiovascular pathology. The study hypothesis is that pathological features of IHD are mirrored in the blood epitranscriptome. The IHD-EPITRAN study focuses on m(6)A and A-to-I modifications of RNA. Patients are recruited from four cohorts: (I) patients with IHD and myocardial infarction undergoing urgent revascularization; (II) patients with stable IHD undergoing coronary artery bypass grafting; (III) controls without coronary obstructions undergoing valve replacement due to aortic stenosis and (IV) controls with healthy coronaries verified by computed tomography. The abundance and distribution of m(6)A and A-to-I modifications in blood RNA are charted by quantitative and qualitative methods. Selected other modified nucleosides as well as IHD candidate protein and metabolic biomarkers are measured for reference. The results of the IHD-EPITRAN study can be expected to enable identification of epitranscriptomic IHD biomarker candidates and potential drug targets.</p

Kehittämisprosessi omaohjaajuuden näkökulmasta. : Luotsin kuntoutuspedagogiikka

Opinnäytetyön tavoitteena oli kehittää omaohjaajuutta Ryhmäkoti Luotsissa työntekijän näkökulmasta ja kuvata omaohjaajuuden kehittämisprosessi. Kehittämisprosessin tarkoituksena oli selkeyttää omaohjaajan tehtävät, rooli ja merkitys Ryhmäkoti Luotsissa. Kehittämisprosessi eteni Engeströmin kehittävän työntutkimuksen avulla kerran kuukaudessa henkilökuntapalavereissa. Työnohjaus-ta hyödynnettiin myös mahdollisuuksien mukaan kehittämisprosessissa. Kehittämisprosessissa käytettiin Engeströmin kehittävää työntutkimusta ja SWOT-analyysiä. Näillä menetelmillä saatiin työyhteisöstä työntekijöiden mielipiteet ja hiljainen tieto näkyväksi. Kehittävä työntutkimus on muutosstrategia, joka yhdistää tutkimuksen ja käytännön kehittämistyön. Siinä Ryhmäkoti Luotsin työntekijät tarkastelivat ja kehittivät työtään omaohjaajuuden osalta. SWOT- analyysissä ryhmitellään yrityksen toimintaan vaikuttavia tekijöitä havainnolliseen nelikenttämuotoon. Nelikentän osa-alueet ovat vahvuus, heikkous, mahdollisuus ja uhka. Kehittämisprosessin aikana Ryhmäkoti Luotsin työryhmän keskusteluissa tulivat esille toimivat käytännöt, joita vahvistettiin, ja lisäksi luotiin uusia toimintamalleja työskentelyn parantamiseksi. Toimivina käytäntöinä työryhmä koki riittävän määrän henkilökuntaa työvuorossa, päivä- ja viikkostruktuuria, yhteisöllisyyden, moniammatillisuuden, nais- ja miestyöntekijät, Luotsin ympäristön ja sijainnin, asioiden tiedottamisen, omaohjaajamenetelmän ja psykiatrinen osaamisen. Uusia menetelmiä työryhmä loi tämän kehittämisprosessin aikana neljä, joita olivat kasvatus- ja kuntoutussuunnitelma, tavoitekartta, mallittaminen ja omaohjaajakäsikirja ja mallikansio. Omaohjaajuuden kehittämisprosessi lisäsi työyhteisön yhteenkuuluvuutta, ja sen koettiin olevan merkityksellinen työmenetelmä. Oma-ohjaajuus on määriteltävä paikkakohtaisesti sopivaksi, koska se silloin sitouttaa ja motivoi työntekijöitä.The aim of this study was to develop the personal advisor´s role in Children’s group home “Luotsi”, from the employee´s point of view and to describe the process of developing the personal advisor role. The development process was designed to clarify the tasks, responsibilities, and the importance of the personal advisor’s role. The work progressed by utilizing the Engeström Developmental Work Research through monthly staff meetings. Advisory supervision was also utilized if possible during the development process. The development process used Engeström´s Developmental Work Research and SWOT-analysis. These methods brought up individual worker´s opinions and made the tacit knowledge more visible. Development Work Research is a strategy for change which combines research and practical development. SWOT-analysis grouped the company´s performance influencing factors into four visible groups. These groups were the strength, weakness, opportunity and threat. In group discussions, the work practices came to the fore and these were strengthened to allow creation of new business models and improve work practices. The working group felt that there was sufficiency regarding the following: staff per shift, day and week structure, mixture of professional skills, environment and location, male and female employees, communication issues, use of personal advisors, and psychiatric expertise. During this development process the working group created four new working methods. These were the educational plan, rehabilitation plan, the target map, and the personal advisor´s guide book and model folder. The personal advisor´s development process increased the cohesion of the working community and it was seen as a significant method of working. The role must be defined to suit the location to ensure it engages and motivates

Detection and Quantification of the Oomycete Saprolegnia parasitica in Aquaculture Environments

Saprolegnia parasitica induces heavy mortality in aquaculture. The detection of S. parasitica is often time consuming and uncertain, making it difficult to manage the disease. We validated a previously published real-time quantitative PCR (qPCR) assay to confirm the presence of S. parasitica in fish and in water using environmental DNA (eDNA) quantification. Analytical sensitivity and specificity of the assay was assessed in silico, in vitro and the qPCR assay was compared with microbiological cultivation methods to detect and quantify S. parasitica in water samples from a controlled fish exposure experiment and from fish farms. Furthermore, we compared the use of an agar cultivation method and the qPCR assay to detect S. parasitica directly from mucus samples taken from the fish surface. The analytical sensitivity and specificity of the qPCR assay were high. The qPCR assay detected 100% of S. parasitica-positive water samples. In a field study, the qPCR assay and a microwell plate (MWP) enumeration method correlated significantly. Furthermore, the qPCR assay could be used to confirm the presence of S. parasitica in skin mucus. Thus, the qPCR assay could complement diagnostic methods in specifically detecting saprolegniosis in fish and used as a surveillance method for S. parasitica pathogen in aquaculture environments