Browsing by Subject "infection"

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  • EFSA Panel Dietetic Products Nutri; Heinonen, Marina (2017)
    Following an application from H.J. Heinz Supply Chain Europe B.V., submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the Netherlands, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to 'Nutrimune (R)' and immune defence against pathogens in the gastrointestinal (GI) tract and upper respiratory tract (URT). The food 'Nutrimune (R)' (a pasteurised cow's skim milk fermented with Lactobacillus paracasei CBA L74) which is the subject of the health claim is sufficiently characterised. The Panel considers that immune defence against pathogens in GI tract and URT is a beneficial physiological effect. One human intervention study from which conclusions can be drawn showed an effect of 'Nutrimune (R)' on immune defence against pathogens in the GI tract and the URT, and the results from one animal study could support an effect of 'Nutrimune (R)' on defence against pathogens in the GI tract. However, there were inconsistencies in the reporting of the process and criteria used for the diagnosis of URTI in the human intervention study, the results of this study have not been replicated, and no evidence was provided for a plausible mechanism by which 'Nutrimune (R)' could exert the claimed effect in vivo in humans. The Panel concludes that the evidence provided is insufficient to establish a cause and effect relationship between the consumption of 'Nutrimune (R)' and immune defence against pathogens in the gastrointestinal and upper respiratory tracts. (C) 2017 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
  • Bohk-Ewald, Christina; Dudel, Christian; Myrskylä, Mikko (2020)
    Background Understanding how widely COVID-19 has spread is critical information for monitoring the pandemic. The actual number of infections potentially exceeds the number of confirmed cases. Development We develop a demographic scaling model to estimate COVID-19 infections, based on minimal data requirements: COVID-19-related deaths, infection fatality rates (IFRs), and life tables. As many countries lack IFR estimates, we scale them from a reference country based on remaining lifetime to better match the context in a target population with respect to age structure, health conditions and medical services. We introduce formulas to account for bias in input data and provide a heuristic to assess whether local seroprevalence estimates are representative for the total population. Application Across 10 countries with most reported COVID-19 deaths as of 23 July 2020, the number of infections is estimated to be three [95% prediction interval: 2–8] times the number of confirmed cases. Cross-country variation is high. The estimated number of infections is 5.3 million for the USA, 1.8 million for the UK, 1.4 million for France, and 0.4 million for Peru, or more than one, six, seven and more than one times the number of confirmed cases, respectively. Our central prevalence estimates for entire countries are markedly lower than most others based on local seroprevalence studies. Conclusions The national infection estimates indicate that the pandemic is far more widespread than the numbers of confirmed cases suggest. Some local seroprevalence estimates largely deviate from their corresponding national mean and are unlikely to be representative for the total population.
  • Flatt, Justin W.; Butcher, Sarah J. (2019)
    Viruses are obligatory parasites that take advantage of intracellular niches to replicate. During infection, their genomes are carried in capsids across the membranes of host cells to sites of virion production by exploiting cellular behaviour and resources to guide and achieve all aspects of delivery and the downstream virus manufacturing process. Successful entry hinges on execution of a precisely tuned viral uncoating program where incoming capsids disassemble in consecutive steps to ensure that genomes are released at the right time, and in the right place for replication to occur. Each step of disassembly is cell-assisted, involving individual pathways that transmit signals to regulate discrete functions, but at the same time, these signalling pathways are organized into larger networks, which communicate back and forth in complex ways in response to the presence of virus. In this review, we consider the elegant strategy by which adenoviruses (AdVs) target and navigate cellular networks to initiate the production of progeny virions. There are many remarkable aspects about the AdV entry program; for example, the virus gains targeted control of a large well-defined local network neighbourhood by coupling several interacting processes (including endocytosis, autophagy and microtubule trafficking) around a collective reference state centred on the interactional topology and multifunctional nature of protein VI. Understanding the network targeting activity of protein VI, as well as other built-in mechanisms that allow AdV particles to be efficient at navigating the subsystems of the cell, can be used to improve viral vectors, but also has potential to be incorporated for use in entirely novel delivery systems.
  • Huck, Olivier; Mulhall, Hannah; Rubin, George; Kizelnik, Zev; Iyer, Radha; Perpich, John D; Haque, Nasreen; Cani, Patrice D; de Vos, Willem M; Amar, Salomon (2020)
    Abstract Aim Akkermansia muciniphila is a beneficial gut commensal, whose anti-inflammatory properties have recently been demonstrated. This study aimed to evaluate the effect of A.muciniphila on Porphyromonas gingivalis elicited inflammation. Material and Methods In lean and obese mice, A.muciniphila was administered in P.gingivalis induced calvarial abcess and in experimental periodontitis model (EIP). Bone destruction and inflammation were evaluated by histomorphometric analysis. In vitro, A.muciniphila was co-cultured with P.gingivalis, growth and virulence factors expression were evaluated. Bone-marrow macrophages (BMM?) and gingival epithelial cells (TIGK) were exposed to both bacterial strains and the expression of inflammatory mediators, as well as tight junction markers was analyzed. Results In a model of calvarial infection, A.muciniphila decreased inflammatory cell infiltration and bone destruction. In EIP, treatment with A.muciniphila resulted in a decreased alveolar bone loss. In vitro, the addition of A.muciniphila to P.gingivalis infected BMM? increased anti-inflammatory IL-10 and decreased IL-12. Additionally, A.muciniphila exposure increases the expression of junctional integrity markers such as integrin-?1, E-cadherin and ZO-1 in TIGK cells. A.muciniphila co-culture with P.gingivalis reduced gingipains mRNA expression. Discussion This study demonstrated the protective effects of A.muciniphila administration and may open consideration to its use as an adjunctive therapeutic agent to periodontal treatment.
  • Veija, Tuukka; Kero, Mia; Koljonen, Virve; Böhling, Tom (2019)
    Aims Merkel cell carcinoma, a rare cutaneous neuroendocrine tumour of the skin, can be categorised into two groups according to Merkel cell polyomavirus (MCV) presence. MCV-negative tumours are more aggressive and frequently associated with gene mutations. Some of the genes are potential therapeutic targets. We have previously reported EGFR mutations in six of 27 MCC tumours and overexpression of ALK and EZH2 at mRNA level in MCC tumours. In this study, we sought to determine expression of ALK, EGFR and EZH2 in MCC samples and assess their correlation to MCV status and clinical parameters. Methods and results Tissue microarrays were utilised and stained with primary antibodies. Staining data were statistically compared to patient sex, tumour location and development of metastasis and MCC-specific death; 112 tumours and their corresponding patient data were included. We found strong expression of ALK in 51% and strong expression of EZH2 in 76% of the tumours. There was evident correlation of ALK expression with MCV-positivity. Expression of EGFR was infrequent, presenting only in seven MCV-negative tumours. None of the proteins associated with development of metastasis or MCC specific death. Conclusions ALK and EZH2 expression are frequent in MCC and ALK expression correlates to MCV positivity. EGFR positive tumours might respond to EGFR inhibiting treatment.
  • Kakkola, L.; Denisova, O. V.; Tynell, J.; Viiliainen, J.; Ysenbaert, T.; Matos, R. C.; Nagaraj, A.; Öhman, Tiina; Kuivanen, S.; Paavilainen, H.; Feng, L.; Yadav, B.; Julkunen, I.; Vapalahti, O.; Hukkanen, V.; Stenman, J.; Aittokallio, T.; Verschuren, E. W.; Ojala, P. M.; Nyman, T.; Saelens, X.; Dzeyk, K.; Kainov, D. E. (2013)
  • Skarp, C. P. A.; Hanninen, M-L; Rautelin, Hilpi I (2016)
    The incidence of human infections caused by Campylobacter jejuni and Campylobacter coil, the main bacterial agents of gastrointestinal disease, has been increasing worldwide. Here, we review the role of poultry as a source and reservoir for Campylobacter. Contamination and subsequent colonization of broiler flocks at the farm level often lead to transmission of Campylobacter along the poultry production chain and contamination of poultry meat at retail. Yet Cainpylobacter prevalence in poultry, as well as the contamination level of poultry products, vary greatly between different countries so there are differences in the intervention strategies that need to be applied. Temporal patterns in poultry do not always coincide with those found in human infections. Studies in rural and urban areas have revealed differences in Campylobacter infections attributed to poultry, as poultry seems to be the predominant reservoir in urban, but not necessarily in rural, settings. Furthermore, foreign travel is considered a major risk factor in acquiring the disease, especially for individuals living in the northern European countries. Intervention strategies aimed at reducing Campylobacter colonization in poultry and focused at the farm level have been successful in reducing the number of Campylobacter cases in several countries. Increasing farm biosecurity and education of consumers are likely to limit the risk of infection. Overall, poultry is an important reservoir and source of human campylobacteriosis, although the contribution of other sources, reservoirs and transmission warrants more research. Clinical Microbiology and Infection (C) 2015 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
  • Bos, Nick; Kankaanpää-Kukkonen, Viljami; Freitak, Dalial; Stucki, Dimitri; Sundström, Liselotte (2019)
    Eusocial insects, such as ants, have access to complex disease defenses both at the individual, and at the colony level. However, different species may be exposed to different diseases, and/or deploy different methods of coping with disease. Here, we studied and compared survival after fungal exposure in 12 species of ants, all of which inhabit similar habitats. We exposed the ants to two entomopathogenic fungi (Beauveria bassiana and Metarhizium brunneum), and measured how exposure to these fungi influenced survival. We furthermore recorded hygienic behaviors, such as autogrooming, allogrooming and trophallaxis, during the days after exposure. We found strong differences in autogrooming behavior between the species, but none of the study species performed extensive allogrooming or trophallaxis under the experimental conditions. Furthermore, we discuss the possible importance of the metapleural gland, and how the secondary loss of this gland in the genus Camponotus could favor a stronger behavioral response against pathogen threats.
  • Kampmann, C.; Dicksved, J.; Engstrand, L.; Rautelin, H. (2016)
    In mice, specific species composition of gut microbiota enhances susceptibility to Campylobacter jejuni but little is known about the specific composition of the human gut microbiota in providing protection from infections caused by enteropathogens. Healthy adult individuals, who travelled in groups from Sweden to destinations with an estimated high risk for acquisition of Campylobacter infection, were enrolled. Faecal samples, collected before travelling and after returning home, were cultured for bacterial enteropathogens, and analysed for Campylobacter by PCR and for the species composition of the microbiota by 16S amplicon massive parallel sequencing. The microbiota compositions were compared between persons who became infected during their travel and those who did not. A total of 63 participants completed the study; 14 became infected with Campylobacter, two with Salmonella and 47 remained negative for the enteropathogens tested. After exclusion of samples taken after antimicrobial treatment, 49 individuals were included in the final analyses. Intra-individual stability of the microbiota was demonstrated for samples taken before travelling. The original diversity of the faecal microbiota was significantly lower among individuals who later became infected compared with those who remained uninfected. The relative abundances of bacteria belonging to the family Lachnospiraceae, and more specifically its two genera Dorea and Coprococcus, were significantly higher among those who remained uninfected. The travel-related infection did not significantly modify the faecal microbiota composition. Species composition of human gut microbiota is important for colonization resistance to Campylobacter infection. Especially individuals with a lower diversity are more susceptible to Campylobacter infection. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
  • Burwick, Richard M.; Lokki, A. Inkeri; Fleming, Sherry D.; Regal, Jean F. (2021)
  • Vainio, Sanna (Helsingfors universitet, 2019)
    Despite the long history of skin grafting, there is no standardized treatment for split-thickness skin graft donor sites. These sites cause a notable amount of pain and discomfort to the patients and open wounds also introduce a risk for infection. There is an extensive need for treatment options promoting the fastest and least painful healing possible while also being infection-free. The treatment of split-thickness skin graft donor sites is constantly studied and there is plenty of scientific literature available about this topic. In the theory section of this Master’s thesis, the structure of skin, the process of wound healing, skin grafting surgery and wound care products for split-thickness skin graft donor sites are briefly introduced. Additionally, the method of systematic review is described. In the empirical section, a systematic review is performed to compare animal- and non-animal-based wound care products in the treatment of split skin graft donor sites. The methodological quality of the included studies is reviewed. In the literature search, 3552 references were found. In this systematic review a total of 23 articles were included comprising of 21 comparative clinical studies and two previous literature reviews. Of the original studies, 20 reviewed healing, 14 infection and 17 pain of the split-thickness skin graft donor sites. Based on the results of the systematic review, animal-based wound care products might promote healing and reduce pain experienced by patients in the treatment of split-thickness skin graft donor sites when compared with non-animal-based wound care products. The results concerning infection were inconsistent. Generally, the reporting of the clinical original studies was not comprehensive enough for proper evaluation of methodological quality. Some defects, mostly in the blinding of the patients, study personnel and the assessors of outcomes, were also found. Moreover, the studies were heterogeneous in their definitions and measuring of the reported outcomes. Therefore, there is substantial uncertainty in the results of this systematic review. The systematic and transparent way of conducting the literature search, the review of the methodological quality and the reporting of the outcomes can be considered as a strength of this thesis. The main weakness is, that only one person performed the critical steps of this study, which might increase the risk of bias and reduce the repeatability of the study.
  • Määttä, Anne; Salminen, Aino; Pietiäinen, Milla; Leskelä, Jaakko; Palviainen, Teemu; Sattler, Wolfgang; Sinisalo, Juha; Salomaa, Veikko; Kaprio, Jaakko; Pussinen, Pirkko (2021)
    Our aim was to analyze whether endotoxemia, i.e. translocation of LPS to circulation, is reflected in the serum metabolic profile in a general population and in participants with cardiometabolic disorders. We investigated three Finnish cohorts separately and in a meta-analysis (n = 7178), namely population-based FINRISK97, FinnTwin16 consisting of young adult twins, and Parogene, a random cohort of cardiac patients. Endotoxemia was determined as serum LPS activity and metabolome by an NMR platform. Potential effects of body mass index (BMI), smoking, metabolic syndrome (MetS), and coronary heart disease (CHD) status were considered. Endotoxemia was directly associated with concentrations of VLDL, IDL, LDL, and small HDL lipoproteins, VLDL particle diameter, total fatty acids (FA), glycoprotein acetyls (GlycA), aromatic and branched-chain amino acids, and Glc, and inversely associated with concentration of large HDL, diameters of LDL and HDL, as well as unsaturation degree of FAs. Some of these disadvantageous associations were significantly stronger in smokers and subjects with high BMI, but did not differ between participants with different CHD status. In participants with MetS, however, the associations of endotoxemia with FA parameters and GlycA were particularly strong. The metabolic profile in endotoxemia appears highly adverse, involving several inflammatory characters and risk factors for cardiometabolic disorders.
  • Pimentel, Andre C.; Beraldo, Camila S.; Cogni, Rodrigo (2021)
    Host shifts, when a cross-species transmission of a pathogen can lead to successful infections, are the main cause of emerging infectious diseases, such as COVID-19. A complex challenge faced by the scientific community is to address the factors that determine whether the cross-species transmissions will result in spillover or sustained onwards infections. Here we review recent literature and present a perspective on current approaches we are using to understand the mechanisms underlying host shifts. We highlight the usefulness of the interactions between Drosophila species and viruses as an ideal study model. Additionally, we discuss how cross-infection experiments - when pathogens from a natural reservoir are intentionally injected in novel host species-can test the effect cross-species transmissions may have on the fitness of virus and host, and how the host phylogeny may influence this response. We also discuss experiments evaluating how cooccurrence with other viruses or the presence of the endosymbiont bacteria Wolbachia may affect the performance of new viruses in a novel host. Finally, we discuss the need of surveys of virus diversity in natural populations using next-generation sequencing technologies. In the long term, these approaches can contribute to a better understanding of the basic biology of host shifts.
  • Fuchs, Siiri-Anna; Sundström, Liselotte; Bos, Nick; Stucki, Dimitri; Freitak, Dalial (2018)
    Parental immune experience can enhance offspring defence mechanisms towards prevalent pathogens in the surrounding environment. This process of inherited resistance from one generation to another is known as trans-generational immune priming (TGIP) in invertebrates. In sedentary and dense insect societies, such as ant colonies, TGIP can influence colony survival and fitness upon pathogen outbreaks. However, TGIP appears to depend on species and environmental stressors and therefore can vary in intensity, as well as in the molecular mechanisms leading to resistance. Here, we stimulated the immune system of queens of the ant Formica fusca (LINNAEUS, 1758) by wounding or injecting dead conidia of the entomopathogenic fungus Beauveria bassiana (BALS.-CRIV.) VUILL. (1912). The offspring were subsequently infected with B. bassiana, and the effect of this priming on survival was evaluated. Furthermore, we investigated whether immune challenge of the mother queen induces changes in the expression of immunity-related genes in queens themselves and their brood. We combined this information with measurements of offspring size and number. Larvae produced by untreated queens had a significantly higher mortality after infection with B. bassiana, whereas those produced by immune-primed queens survived no worse than unexposed ones. Adult worker offspring from sham-control mothers showed a protective effect of queen treatment, consistent with transgenerational immune priming. Thus, the effects of queen priming appear to manifest themselves slightly differently in larval and adult offspring. No differences were detected in offspring number or size, but immune gene expression levels showed changes, both in queens and their offspring.
  • Maleta, Kenneth; Fan, Yue-Mei; Luoma, Juho; Ashorn, Ulla; Bendabenda, Jaden; Dewey, Kathryn G.; Hyöty, Heikki; Knip, Mikael; Kortekangas, Emma; Lehto, Kirsi-Maarit; Matchado, Andrew; Nkhoma, Minyanga; Nurminen, Noora; Parkkila, Seppo; Purmonen, Sami; Veijola, Riitta; Oikarinen, Sami; Ashorn, Per (2021)
    Background: Insulin-like growth factor I (IGF-I) is the most important hormonal promoter of linear growth in infants and young children. Objectives: The objectives of this study were to compare plasma IGF-I concentration in a low- compared with a high-income country and characterize biological pathways leading to reduced IGF-I concentration in children in a low-income setting. Methods: We analyzed plasma IGF-I concentration from 716 Malawian and 80 Finnish children at 6-36 mo of age. In the Malawian children, we studied the association between IGF-I concentration and their environmental exposures; nutritional status; systemic and intestinal inflammation; malaria parasitemia and viral, bacterial, and parasitic enteric infections; as well as growth at 18 mo of age. We then conducted a pathway analysis to identify direct and indirect associations between these predictors and IGF-I concentration. Results: The mean IGF-I concentrations were similar in Malawi and Finland among 6-mo-old infants. At age 18 mo. the mean +/- SD concentration was almost double among the Finns compared with the Malawians [24.2 +/- 11.3 compared with 12.5 +/- 7.7 ng/mL., age- and sex-adjusted difference in mean (95% CI): 11.8 (9.9. 13.7) ng/mL; P <0.01]. Among 18-mo-old Malawians, plasma IGF-I concentration was inversely associated with systemic inflammation, malaria parasitemia, and intestinal Shigella. Campylobacter, and enterovirus infection and positively associated with the children's weight-for-length z score (WLZ), female sex, maternal height, mother's education, and dry season. Seasonally, mean plasma IGF-I concentration was highest in June and July and lowest in December and January, coinciding with changes in children's length gain and preceded by similar to 2 mo by the changes in their WLZ. Conclusions: The mean plasma IGF-I concentrations are similar in Malawi and Finland among 6-mo-old infants. Thereafter, mean concentrations rise markedly in Finland but not in Malawi. Systemic inflammation and clinically nonapparent infections are strongly associated with lower plasma IGF-I concentrations in Malawi through direct and indirect pathways.
  • Arola, Anita; Pikkarainen, Essi; Sipilä, Jussi O. T.; Pykäri, Jouni; Rautava, Päivi; Kytö, Ville (2017)
    Background-Epidemiology of myocarditis in childhood is largely unknown. Men are known to have a higher incidence of myocarditis than women in adults aged Methods and Results-Data of all hospital admissions with myocarditis in Finland occurring in patients aged Conclusions-Myocarditis leading to hospital admission is relatively uncommon in children, but occurrence of myocarditis increases with age. There is no sex difference in the risk of myocarditis during the first 6 years of life, but boys have a significantly higher risk at ages 6 to 15 years.
  • Heinola, Ivika; Sörelius, Karl; Wyss, Thomas R.; Eldrup, Nikolaj; Settembre, Nicla; Setacci, Carlo; Mani, Kevin; Kantonen, Ilkka; Venermo, Maarit (2018)
    Background-The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. Methods and Results-All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). Conclusions-Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.
  • Sikiö, Jenna (Helsingin yliopisto, 2017)
    Background: Some oral health factors have been associated with a higher risk for head and neck cancers (HNCs) and most clearly the existing evidence refers to an association between periodontitis and HNC. Aims: To examine oral health in a subset of HNC patients, namely patients with oropharyngeal cancer (OPC) or oral cavity cancer (OCC), and to compare these two tumor sites in this regard. Subjects and Methods: A retrospective study consisting of a series of OPC and OCC patients diagnosed between 2005-2008 at the Helsinki University Hospital, Helsinki, Finland. Study subjects were randomly selected from hospital registries. Oral health at diagnosis was assessed by reviewing the corresponding panoramic radiographs. We used modified Total Dental Index (Mattila et al. 1989) to assess oral health as a whole. Results: In univariate analysis the difference in modified Total Dental Index (mean 3,49 ±0,20 for OPC vs. 2,85 ±0,22 for OCC) was statistically significant, but after adjusting for age, gender, smoking, and heavy alcohol consumption statistical significance was lost. When individual dental variables were considered, the only statistically significant difference in univariate analysis was found concerning residual roots (mean 0,60 ±0,21 for OPC vs. 0,19 ±0,15 for OCC). Conclusions: The present findings demonstrate a fairly poor oral health status among oral and oropharyngeal cancer patients. The observed prevalence of caries and periodontitis seems to be even more common than among the Finnish general population. Whether or not there are differences in oral health risk factors between OPC and OCC patients cannot be reliably established in this study. Further studies with larger sample sizes are needed to confirm our findings either way.
  • Kiss, Jan; Stark, Christoffer; Nykaäen, Antti; Lemström, Karl (2020)
    Objectives. We present the outcome of the first 80 patients receiving a continuous flow left ventricular assist device at Helsinki University Hospital between December 2011 and November 2018. Design. This was a single-center retrospective study. We describe our patient management in detail. The primary end-points were death, heart transplantation, or pump explant. Data was reported in accordance with the Interagency Registry for Mechanical Circulatory Support protocol. All patients receiving an assist device during the study period were included in the data analysis. Results. Mean patient age was 53 +/- 12 years at implantation and 85% were male. Most patients suffered from dilated (48%), or ischemic (40%) cardiomyopathy. One-third of patients were bridged with venoarterial extracorporeal membrane oxygenation to assist device implantation. Implant strategy was bridge to transplant or bridge to decision in most patients (88%). Mean follow-up time on pump was 529 +/- 467 days. Survival was 98, 92, 85, 79 and 71% at 1, 3, 12, 24 and 36 months, respectively. Most common causes of death were multi-organ failure, right heart failure, or stroke. Only three patients (4%) had suspected pump thrombosis, two of which resolved with medical treatment and one resulting in death. Pump exchange or explant were not performed in a single patient. Neurological events occurred in 18%, non-disabling stroke in 8%, and fatal stroke in 4% of the patients. The incidence of device-related infection was 10%. Conclusions. Survival rates were good, although one third of patients were bridged with temporary circulatory support. We report a high level of freedom from pump thrombosis, fatal stroke, and driveline infection.
  • Hänninen-Khoda, L.; Koljonen, V.; Ylä-Kotola, T. (2018)
    Late cancellations of scheduled operations cause direct and indirect costs for a hospital and economic and emotional stress for the patient. Previously, late cancellation rates for scheduled operations in plastic surgery have been shown to be attributable to patient-related causes in the majority of cases. In this retrospective study, we sought to examine specifically the patient-related reasons for the late cancellations in a plastic surgery operating theatre at Helsinki University Hospital in Finland from 2013 to 2014. We calculated latency between the date of decision for surgery and the scheduled operation day. In cases where the surgery was rescheduled and performed before 31 December 2015, the rescheduled waiting time latency was calculated. We aimed to improve our knowledge of the causes of late cancellations to further optimise the operating theatre efficiency and propose a strategic algorithm to avoid late cancellations During the study period, 327 (5.5%) of all the scheduled operations were recorded as late cancellations. Of these, 45.3% were because of patient-related issues. Acute infection, change in medical condition not noticed before and operation no longer necessary were by far the most common causes of cancellation, comprising 63.5%. Sixty-six per cent of patient-related cancelled operations were performed later, especially when the specific reason was patient's acute illness. Root-cause analysis shows that most of the underlying reasons for the cancellations can be attributed to a failure in communication. The majority of these cancellations were considered to be preventable, thus emphasising the importance of communication and skilful multi-professional planning of the operating theatre list. © 2018 The Author(s)