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Jantunen E.,Kuopio University Hospital | Jantunen E.,University of Eastern Finland | Kuittinen T.,Kuopio University Hospital | Mahlamaki E.,Eastern Finland Laboratory Center | And 3 more authors.
European Journal of Haematology | Year: 2011

A significant proportion of patients with lymphoid malignancies are hard-to-mobilize with a combination of chemotherapy plus granulocyte colony-stimulating factor (G-CSF) (chemomobilization). Plerixafor is a novel drug used to improve mobilization of blood stem cells. However, it has been studied mainly in association with G-CSF mobilization. We evaluated the efficacy of 'pre-emptive' use of plerixafor after chemomobilization in patients who seem to mobilize poorly. During a 15month period, altogether 63 patients with lymphoid malignancies were admitted to our department for blood stem cell collection. Sixteen patients (25%) received plerixafor after the first mobilization due to the low blood (B) CD34+ cell counts (n=12) or poor yield of the first collection (n=4). The median number of plerixafor injections was 1 (1-3). The median B-CD34+ count after the first plerixafor dose was 39×106/L (<1-81) with the median increase of fivefold. Stem cell aphaereses were performed in 14/16 patients (88%) receiving plerixafor and a median of 2.9×106/kg (1.6-6.1) CD34+ cells were collected with a median of one aphaeresis (1-3). Altogether 13/16 patients mobilized with a combination of chemomobilization and plerixafor received high-dose therapy with stem cell support and all engrafted. Pre-emptive use of plerixafor after chemomobilization is efficient and safe and should be considered in poor mobilizers to avoid collection failure. In patients with low but rising B-CD34+ counts, the use of plerixafor might be delayed as late mobilization may occur. Further studies are needed to optimize patient selection and timing of plerixafor. © 2011 John Wiley & Sons A/S.

Nieminen P.,University of Eastern Finland | Kakela R.,University of Helsinki | Paakkonen T.,University of Eastern Finland | Halonen T.,Eastern Finland Laboratory Center | Mustonen A.-M.,University of Eastern Finland
Journal of Insect Physiology | Year: 2013

Poikilothermic organisms often modify their tissue fatty acids (FA) in response to cold exposure by increased unsaturation. In insects, this has been found to be accompanied by increases in the activities or mRNA expression of desaturase enzymes. In the present study, the FA composition of an obligatory ectoparasite, the deer ked (Lipoptena cervi), was analyzed in August-November. In addition to studying the general FA profile of the species, the possible contribution of FA to autumnal cold-hardening was examined. The FA composition of the deer ked imago was relatively similar to previously studied dipteran species, with high percentages of monounsaturated FA (especially 18:1n-9 and 16:1n-7) and 16:0. The individuals caught later in autumn had significantly higher values for the ratio of unsaturated to saturated FA and, regarding individual FA, the percentages of 18:1n-9, 18:2n-6, 18:3n-3, 20:4n-6 and 22:6n-3 were higher but those of 16:0 and 16:1n-7 lower than in August. Potential selective use of particular FA for energy could not account for the large increase in the levels of polyunsaturated FA (PUFA). The observed increased degree of FA unsaturation may have resulted from cold-induced desaturation, as observed previously in other species, or increased survival of the keds with relatively large PUFA contents. The PUFA with low melting points probably allow lipid membranes to maintain sufficient fluidity required to maintain protein functions at low ambient temperatures. © 2013 Elsevier Ltd.

Koskela H.O.,Kuopio University Hospital | Koskela H.O.,University of Eastern Finland | Salonen P.H.,Kuopio University Hospital | Romppanen J.,Eastern Finland Laboratory Center | And 2 more authors.
BMJ Open | Year: 2014

Objectives: Community-acquired pneumonia is associated with a significant long-term mortality after initial recovery. It has been acknowledged that additional research is urgently needed to examine the contributors to this long-term mortality. The objective of the present study was to assess whether diabetes or newly discovered hyperglycaemia during pneumonia affects long-term mortality. Design: A prospective, observational cohort study. Setting: A single secondary centre in eastern Finland. Participants: 153 consecutive hospitalised patients who survived at least 30 days after mild-to-moderate community-acquired pneumonia. Interventions: Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The surveillance status and causes of death were recorded after median of 5 years and 11 months. Results: In multivariate Cox regression analysis, a previous diagnosis of diabetes among the whole population (adjusted HR 2.84 (1.35-5.99)) and new postprandial hyperglycaemia among the non-diabetic population (adjusted HR 2.56 (1.04-6.32)) showed independent associations with late mortality. New fasting hyperglycaemia was not an independent predictor. The mortality rates at the end of follow-up were 54%, 37% and 10% among patients with diabetes, patients without diabetes with new postprandial hyperglycaemia and patients without diabetes without postprandial hyperglycaemia, respectively (p<0.001). The underlying causes of death roughly mirrored those in the Finnish general population with a slight excess in mortality due to chronic respiratory diseases. Pneumonia was the immediate cause of death in just 8% of all late deaths. Conclusions: A previous diagnosis of diabetes and newly discovered postprandial hyperglycaemia increase the risk of death for several years after community-acquired pneumonia. As the knowledge about patient subgroups with an increased late mortality risk is gradually gathering, more studies are needed to evaluate the possible postpneumonia interventions to reduce late mortality.

Turtiainen J.,North Karelia Central Hospital | Hakala T.,North Karelia Central Hospital | Hakkarainen T.,North Karelia Central Hospital | Karhukorpi J.,Eastern Finland Laboratory Center
European Journal of Vascular and Endovascular Surgery | Year: 2014

Objective: To study the relationship between surgical wound bacterial colonization and the development of surgical site infection (SSI) after lower limb vascular surgery. SSI is a major problem after lower limb vascular surgery. Most SSIs in vascular surgery are caused by Staphylococcal species that are part of normal skin flora. A prospective observational investigator blind study to examine quantitative and qualitative analysis of surgical wound bacterial colonization and the correlation with the development of SSI has been conducted. Methods: The study cohort comprised 94 consecutive patients with 100 surgical procedures. Swabs for microbiological analyses were taken from surgical wounds at four different time intervals: before surgery, just before the surgical area had been scrubbed, at the end of surgery, and on the first and second postoperative days. Postoperative complications were recorded. Results: Three hundred and eighty-seven skin bacterial samples from 100 surgical wounds were analyzed. The most common bacteria isolated were coagulase-negative staphylococci (80%), Corynebacterium species (25%), and Propionibacterium species (15%). In 13 (62%) cases, the same bacterial isolates were found in the perioperative study samples as in the infected wounds. The incidence of SSI was 21%. Multivariate analysis revealed that high bacterial load on the second postoperative day and diabetes independently increased the risk of SSI. Elective redo surgery was protective against the development of SSI. Conclusions: A high bacterial load in the postoperative surgical wound independently increases the risk of the development of SSI after lower limb vascular surgery. © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Koskela H.O.,Kuopio University Hospital | Purokivi M.K.,Kuopio University Hospital | Romppanen J.,Eastern Finland Laboratory Center
Clinical Respiratory Journal | Year: 2010

Background and Aims: Chronic cough is associated with an enhanced excitability of airway cough receptors, possibly due to action of neurotrophins. The present study aimed to compare the neurotrophin levels between healthy subjects and patients with chronic cough and to analyze the factors associated with these levels. Methods: Serum and sputum levels of nerve growth factor (NGF), serum levels of brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) were analyzed by enzyme immunoassay in 19 healthy subjects and 47 patients with chronic cough. In addition, cough sensitivity to hypertonic saline was assessed, cough diary was kept, Leicester Cough Questionnaire was filled in, peak flow was monitored and spirometry, skin prick tests, exhaled nitric oxide measurement and histamine challenge were performed. Results: The NGF levels did not differ between the healthy subjects and the patients with chronic cough and were not associated with any index describing cough severity. However, these levels in both serum (P = 0.01) and sputum (P = 0.025) samples were associated with asthma. There was a statistically significant association between serum and sputum NGF levels (R = 0.45, P = 0.026). The serum BDNF levels did not differ between the groups and were not associated with any of the background characteristics. The serum NT-3 levels were below the detection limit in most subjects and therefore these data were not analyzed. Conclusions: Neither chronic cough nor its severity is associated with abnormal neurotrophin levels. High NGF levels among some patients with chronic cough may indicate a presence of asthma. © 2009 Blackwell Publishing Ltd.

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