Association among blood pressure, end-tidal carbon dioxide, peripheral oxygen saturation and mortality in prehospital post-resuscitation care.

Aim: Post-resuscitation care is described as the fourth link in a chain of survival in resuscitation guidelines. However, data on prehospital post-resuscitation care is scarce. We aimed to examine the association among systolic blood pressure (SBP), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide (EtCO2) after prehospital stabilisation and outcome among patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods: In this retrospective study, we evaluated association of the last measured prehospital SBP, SpO2 and EtCO2 before patient handover with 30-day and one-year mortality in 2,611 patients receiving prehospital post-resuscitation care by helicopter emergency medical services in Finland. Statistical analyses were completed through locally estimated scatterplot smoothing (LOESS) and multivariable logistic regression. The regression analyses were adjusted by sex, age, initial rhythm, bystander CPR, and time interval from collapse to the return of spontaneous circulation (ROSC). Results: Mortality related to SBP and EtCO2 values were U-shaped and lowest at 135 mmHg and 4.7 kPa, respectively, whereas higher SpO2 shifted towards lower mortality. In adjusted analyses, increased 30-day mortality and one year mortality was observed in patients with SBP < 100 mmHg (OR 1.9 [95% CI 1.4-2.4]) and SBP < 100 (OR 1.8 [1.2-2.6]) or EtCO2 < 4.0 kPa (OR 1.4 [1.1-1.5]), respectively. SpO2 was not significantly associated with either 30-day or one year mortality. Conclusions: After prehospital post-resuscitation stabilization, SBP < 100 mmHg and EtCO2 < 4.0 kPa were observed to be independently associated with higher mortality. The optimal targets for prehospital post-resuscitation care need to be established in the prospective studies.

Differential diagnosis and cause-specific treatment during out-of-hospital cardiac arrest: a retrospective descriptive study.

BACKGROUND: The cardiopulmonary resuscitation (CPR) guidelines recommend identifying and correcting the underlying reversible causes of out-of-hospital cardiac arrest (OHCA). However, it is uncertain how often these causes can be identified and treated. Our aim was to estimate the frequency of point of care ultrasound examinations, blood sample analyses and cause-specific treatments during OHCA. METHODS: We performed a retrospective study in a physician-staffed helicopter emergency medical service (HEMS) unit. Data on 549 non-traumatic OHCA patients who were undergoing CPR at the arrival of the HEMS unit from 2016 to 2019 were collected from the HEMS database and patient records. We also recorded the frequency of ultrasound examinations, blood sample analyses and specific therapies provided during OHCA, such as procedures or medications other than chest compressions, airway management, ventilation, defibrillation, adrenaline or amiodarone. RESULTS: Of the 549 patients, ultrasound was used in 331 (60%) and blood sample analyses in 136 (24%) patients during CPR. A total of 85 (15%) patients received cause-specific treatment, the most common ones being transportation to extracorporeal CPR and percutaneous coronary intervention (PCI) (n = 30), thrombolysis (n = 23), sodium bicarbonate (n = 17), calcium gluconate administration (n = 11) and fluid resuscitation (n = 10). CONCLUSION: In our study, HEMS physicians deployed ultrasound or blood sample analyses in 84% of the encountered OHCA cases. Cause-specific treatment was administered in 15% of the cases. Our study demonstrates the frequent use of differential diagnostic tools and relatively infrequent use of cause-specific treatment during OHCA. Effect on protocol for differential diagnostics should be evaluated for more efficient cause specific treatment during OHCA.

Modification of pine pulp during oxygen delignification by xylan self-assembly.

Self-assembly is a technique of preparing functional materials based on targeted intermolecular interactions involving different macromolecules. In this work, hardwood xylan was disassembled from wood and birch bleached kraft pulp using pressurized hot water extraction (HWX) and cold alkali extraction (CAX), respectively. The extracted biopolymers were characterized using gas chromatography (GC), size exclusion chromatography (SEC) and Fourier transform infrared spectroscopy (FTIR), and subsequently added into an oxygen delignification reactor containing pine kraft pulp. The assembly of xylan-pulp fiber was characterized using advanced time-of-flight secondary ion mass spectrometry (ToF-SIMS) and imaging. The xylan-pine pulp assembly was not significantly removed during the whole elemental chlorine free bleaching sequence or during low consistency refining. Modified fibers had superior mechanical properties compared to the reference pulp. Our concept can be easily applied in the pulp and paper industry, and it opens new possibilities for the utilization of fully bio-based fibers in new materials.

Photoresponsive cellulose fibers by surface modification with multifunctional cellulose derivatives.

Eucalyptus bleached kraft pulp fibers were modified by adsorption of novel bio-based multifunctional cellulose derivatives in order to generate light responsive surfaces. The cellulose derivatives used were decorated with both cationic groups (degree of substitution, DS of 0.34) and photoactive groups (DS of 0.11 and 0.37). The adsorption was studied by UV-vis spectroscopy, surface plasmon resonance (SPR) and time-of-flight secondary ion mass spectroscopy (ToF-SIMS). The adsorption isotherms followed the Freundlich model and it turned out that the main driving force for the adsorption was electrostatic interaction. Moreover, strong indications for hydrophobic interactions between the fibers and the derivatives and the derivatives themselves were found. ToF-SIMS imaging revealed an even distribution of the derivatives on the fiber surfaces. The modified fibers underwent fast photocrosslinking under UV-irradiation as demonstrated by light absorbance and fluorescence measurements. Thus, our results proved that the modified fibers exhibited light-responsive properties and can potentially be used for the manufacture of smart bio-based materials.

Topochemistry of environmentally friendly pretreatments to enhance enzymatic hydrolysis of sugar cane bagasse to fermentable sugar.

In this work, dilute alkaline and alkaline peroxide pretreatments were conducted in comparison with hydrotropic pretreatment to improve the delignification of bagasse prior to enzymatic hydrolysis. The surface chemical composition of bagasse after pretreatments was investigated by X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS). The surface distribution of lignin and extractives on the bagasse fiber was significantly changed by dilute alkaline, alkaline peroxide, and hydrotropic pretreatments. Hydrotropic pretreatment typically showed, other than the decrease of surface coverage by lignin and extractives, dramatic removal of xylan, thereby leading to more cellulose exposed on the fiber surface after pretreatment. Fiber morphology after pretreatments was more favorable for enzyme hydrolysis as well. However, the hydrotropic treatment had clear advantages because the enzymatic hydrolysis yields of glucan and xylan of pretreated bagasse were 83.9 and 14.3%, respectively.

Topochemistry of alkaline, alkaline-peroxide and hydrotropic pretreatments of common reed to enhance enzymatic hydrolysis efficiency.

Common reed was studied as raw material for sugar bioconversion. The low temperature alkaline, alkaline-peroxide and hydrotropic pretreatments were employed to overcome the recalcitrance of reed before enzymatic hydrolysis. After pretreatments, lignin was efficiently decreased from the fiber cell wall. Xylan was significantly reduced by hydrotropic pretreatment as well. The surface chemical compositions of reed before and after pretreatments were investigated by X-ray spectroscopy (XPS) and time of flight secondary ion mass spectrometry (ToF-SIMS). Reed had a high surface coverage by lignin. Hydrotropic pretreatment was outstanding to decrease the surface coverage by lignin and expose the polysaccharides to fiber surface. The surface lignin reduction was also supported by attenuated total reflectance (ATR)-FTIR results. Furthermore, the topochemical modification of the fiber wall by hydrotropic pretreatment could improve the fiber digestibility, and thus the maximum glucan and xylan yields with the cellulase dosage of 20 FPU/g raised to 93.1% and 25.5%, respectively.

Charge-directed fiber surface modification by molecular assemblies of functional polysaccharides.

Molecular assemblies, namely, polyelectrolyte complexes (PECs) composed of negatively charged xylan-based derivatives and a novel positively charged cellulose derivative (CN(+)), were used for interfacial modification of wood fibers by charge directed self-assembly. The adsorption process was studied using polyelectrolyte titration and elemental analysis. X-ray spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) were used as advanced techniques for the characterization of the modified fiber surfaces. The measurements revealed an intense interaction between the pulp fibers and PECs, and provided essential information for a better understanding of the adsorption process. The information gathered on this paper might contribute to the basis for the development of new value added products by the use of underutilized biomass.

[Update on current care guidelines: diagnosis and treatment of sexually transmitted infections]. / Sukupuolitautien diagnostiikka ja hoito.

Recognition of common sexually transmitted infection (STI) syndromes allows more efficient diagnosis and treatment. These evidence-based guidelines provide advice on the management of STIs, including the use of the appropriate diagnostic methods and therapeutic regimens. Early and appropriate therapy has the potential to significantly reduce the long-term complications of STIs. The prevention of further infection through the counselling and treatment of partners contributes to the sexual health of patients.

[Update on current care guidelines. Diagnosis, treatment and follow-up of cytological changes in the cervix, vagina and vulva]. / Kohdunkaulan, emättimen ja ulkosynnytinten solumuutokset--diagnostiikka, hoito ja seuranta.

Approximately 150 cervical cancer cases are diagnosed in Finland annually. Both incidence and mortality have decreased by 80% since organised screening began. Recently, screening based on primary HPV-testing with Pap-smear triage has been shown to be more sensitive and more specific among women over 35 years old in randomised studies and thus may be implemented in routine. Abnormal findings in Pap smears indicate management. Confirmed CIN1 lesions are followed up and CIN2 and worse lesions treated. Follow-up after treatment should be reliably arranged, because elevated risk of cancer remains over 20 years after treatment. Quality control is of utmost importance.