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11.
Lillrank P Liukko M 《International journal of health care quality assurance incorporating Leadership in health services》2004,17(1):39-46
Quality management methods have been introduced into health care with variable success. Industrial approaches, such as standardization, are not always applicable professional services, because of fundamental differences in conceptions of aims and the predictability of the results of action. Processes in health care can be classified into standard, routine and non-routine depending on the level of repetition and amount of variation, variety and uncertainty. Quality problems are different in each type: standard processes may produce deviations from targets, routines errors in classification, and non-routines failures in interpretation. Different management approaches for each type are discussed. A metaphor to assist discussion, The Broom, is introduced. 相似文献
12.
Riikka Juntunen Aino Liukko Antti Taivainen Ale Nrvnen Guillaume Durand Anu Kauppinen Anssi Nieminen Marja Rytknen-Nissinen Soili Saarelainen Bernard Maillre Tuomas Virtanen Tuure Kinnunen 《Molecular immunology》2009,46(16):3320-3327
We have previously proposed that mammalian lipocalin allergens are recognized suboptimally by the human immune system due to their homology with endogenous lipocalins. Here, we have characterized in detail the human T cell recognition of one of the previously identified T cell epitopes of the major dog allergen Can f 1, contained in peptide p105–120. A panel of peptide analogues (altered peptide ligands, APLs) of p105–120 was tested on two specific T cell clones restricted by different human leukocyte antigen (HLA) alleles. Interestingly, we identified for both of the clones several heteroclitic APLs that were capable of stimulating them at 10–30-fold lower concentrations than the natural peptide. Moreover, one of the heteroclitic APLs identified with the T cell clones, L115F, was observed to induce a stronger polyclonal T cell response than the natural allergen peptide from the peripheral blood mononuclear cells (PBMCs) of six Can f 1-allergic subjects studied. The heteroclitic APLs bound with the same affinity as p105–120 to common HLA-DR- and HLA-DP-alleles, suggesting that their improved stimulatory capacity is attributable to a more efficient T cell receptor (TCR) recognition rather than increased HLA binding. Collectively, our data suggest that p105–120 is recognized suboptimally by human T cells. This may contribute to the allergenicity of Can f 1. 相似文献
13.
Jyri Hukki Martti Attila Heimo Haikala Maaret Castren Tapani Lhteenmki Karl V. Smitten Timo Waris 《Microsurgery》1989,10(2):110-112
Supradiaphragmatic inferior vena cava was transplanted end-to-end into the abdominal aorta of 11-week-old rats of the same inbred strain and same litter using microvascular technique. The grafts were removed 3 days, 4, 8, 16, and 35 weeks postoperatively, and their noradrenaline (NA) content was estimated by high-performance liquid chromatography using electrochemical detection. The amount of NA was significantly lower (P less than .001) in all vein grafts as compared to nontransplanted vena cava. The substantial decrease of NA in the vein grafts throughout the observation period indicates a persistent denervation of the transplant. 相似文献
14.
Helena Tuunanen Johanna Kuusisto Jyri Toikka Pertti Jääskeläinen Päivi Marjamäki Keijo Peuhkurinen Tapio Viljanen Petri Sipola Kira Q. Stolen Jarna Hannukainen Pirjo Nuutila Markku Laakso Juhani Knuuti 《Journal of nuclear cardiology》2007,14(3):354-365
Background The relationship between myocardial metabolic changes and the severity of left ventricular (LV) hypertrophy in patients with
hypertrophic cardiomyopathy (HCM) is largely unknown. We characterized metabolic abnormalities in patients with a genetically
identical cause for HCM but with variable LV hypertrophy.
Methods and Results Eight patients with HCM attributable to the Asp175Asn mutation in the α-tropomyosin gene underwent myocardial perfusion, oxidative,
and free fatty acid (FFA) metabolism measurements via positron emission tomography and oxygen 15-labeled water, carbon 11
acetate, and fluorine 14(R,S)-[18F] Fluoro-6-thia-heptadecanoic acid (18 FTHA). LV mass, work, and efficiency were assessed
by echocardiography. Thirty-six healthy volunteers served as control subjects. Compared with control subjects, HCM patients
had increased myocardial oxidative metabolism and FFA uptake (P<.05). However, in patients, LV mass was inversely related to global myocardial perfusion, oxidative metabolism, and FFA uptake
(all P<.03), and regional wall thickness was inversely related to regional perfusion (P<.01), oxidative metabolism (P<.001), and FFA uptake (P<.01). Therefore patients with mild (LV mass less than median of 177 g) but not advanced LV hypertrophy were characterized
by increased perfusion, oxidative metablism, and LV efficiency as compared with control subjects (P<.05).
Conclusions In HCM attributable to the Asp 175Asn mutation in the α-tropomyosin gene, myocardial oxidative metabolism and FFA metabolism
are increased and inversely related to LV hypertrophy at both the whole heart and regional level. Increased metabolism and
efficiency characterize patients with mild myocardial hypertrophy. These hypermetabolic alterations regress with advanced
hypertrophy.
Dis Tuunanen and Kuusisto contributed equally to this work
This study was financially supported by an EVO grant (Kuopio University Hospital), as well as the Turunen Foundation, Instrumentarium
Foundation, and Finish Cultural Foundation. 相似文献
15.
Ectopic pregnancies were studied in two Finnish hospitals in the years 1973 – 1976. A total of 238 cases was found. Of these, 30 (12.6 %) occurred in woman using low-dose progestogens for oral contraception. When sales figures for different progestogens sold in the areas served by the hospitals were obtained, the risk of ectopic pregnancy could be assessed for each progestogen. The risk factor was found to be 1 ectopic pregnancy in 1170 women years with lynestrenol 0.5 mg, 1/290 with norethisterone 0.3 mg, and 1/250 with d-norgestrel 0.03 mg. Lynestrenol 0.5 mg carries a significantly lower risk of ectopic pregnancy (p < 0.01) than other progestogens. 相似文献
16.
P Kiilholma M Gr?nroos P Liukko P Pakarinen H Hy?r? R Erkkola 《Gynecologic and obstetric investigation》1984,18(4):212-216
Serum concentrations of copper (Cu) and zinc (Zn) were determined in 20 non-pregnant healthy menstruating women and in 20 pregnant women during the 1st, 2nd and 3rd trimesters and 5 weeks postpartum as a longitudinal study. Also a cross-sectional population of 106 women was studied. Further, Cu and Zn concentrations were measured in 13 pregnant women who gave birth to small-for-date (SFD) infants; this was done during the 3rd trimester of pregnancy. The serum Cu concentration in nonpregnant women was 0.91 +/- 0.19 mg/l. During pregnancy it was significantly higher (1.48 +/- 0.31, 1.91 +/- 0.25 and 2.20 +/- 0.36 mg/l during the 1st, 2nd and 3rd trimesters, respectively) and 5 weeks postpartum it was still higher (1.09 +/- 0.17 mg/l) than in the nonpregnant women. In the cross-sectional population, serum Cu and Zn values were of the same magnitude as in the longitudinal study. When longitudinal and cross-sectional values of serum Cu during the 3rd trimester were combined, the mean level (2.23 +/- 0.40 mg/l) was significantly higher than that in the SFD group (2.06 +/- 0.25 mg/l). Serum Zn in the SFD group (0.48 +/- 0.12 mg/l) did not differ significantly from the normal pregnant values. 相似文献
17.
J. Kanto M.D. R. Virtanen E. Iisalo K. Mäenpää P. Liukko 《Acta anaesthesiologica Scandinavica》1981,25(2):85-88
The placental transfer and pharmacokinetics of atropine were studied in 44 healthy parturients undergoing caesarean section. The concentrations in the plasma were determined by a new radioimmunoassay after intravenous (n = 32) or after intramuscular (n = 12) administration of 0.01 mg/kg of atropine. A fast placental transfer with apparent foetal uptake of the drug was found after intravenous injection. There was also a difference in the umbilical vein and artery concentrations after intramuscular administration. The maternal pharmacokinetics of i.v. atropine obeyed a two-compartment open model with a fast distribution phase (mean tα1/2 = 1.02 min) and quite fast elimination (t1/2 = 2.56 h). The total apparent volume of distribution was 1.0 1/kg and the total plasma clearance 6.36 ml/min/kg. The mean peak maternal plasma levels after i.m. atropine administration were found at 1.59 h and the mean calculated half-life of elimination was then 2.1 h. No atropine was found in the amniotic fluid. 相似文献
18.
Robert S Armiger Mehran Armand Jyri Lepisto Davneet Minhas Kaj Tallroth Simon C Mears Matthew D Waites Russell H Taylor 《Computer aided surgery》2007,12(4):215-224
Periacetabular osteotomy (PAO) is intended to treat a painful dysplastic hip. Manual radiological angle measurements are used to diagnose dysplasia and to define regions of insufficient femoral head coverage for planning PAO. No method has yet been described that recalculates radiological angles as the acetabular bone fragment is reoriented. In this study, we propose a technique for computationally measuring the radiological angles from a joint contact surface model segmented from CT-scan data. Using oblique image slices, we selected the lateral and medial edge of the acetabulum lunate to form a closed, continuous, 3D curve. The joint surface is generated by interpolating the curve, and the radiological angles are measured directly using the 3D surface. This technique was evaluated using CT data for both normal and dysplastic hips. Manual measurements made by three independent observers showed minor discrepancies between the manual observations and the computerized technique. Inter-observer error (mean difference +/- standard deviation) was 0.04 +/- 3.53 degrees for Observer 1; -0.46 +/- 3.13 degrees for Observer 2; and 0.42 +/- 2.73 degrees for Observer 3. The measurement error for the proposed computer method was -1.30 +/- 3.30 degrees . The computerized technique demonstrates sufficient accuracy compared to manual techniques, making it suitable for planning and intraoperative evaluation of radiological metrics for periacetabular osteotomy. 相似文献
19.
The effect of ritodrine to the mother on plasma renin activity (PRA) in the mother and fetus was examined in 10 mothers coming to elective cesarean section. 10 comparable mothers without ritodrine infusion served as controls. At the end of 2 h infusion of ritodrine, the mean maternal PRA was significantly (p less than 0.001) higher than in the control group. Also the mean PRA levels in the umbilical vein (p less than 0.001) and umbilical artery (p less than 0.01) were significantly higher after ridodrine infusion to the mother than the respective levels in the control group. 相似文献
20.
R. Punnonen P. Liukko J. Cortes-Prieto F. Eydam S. Milojevic R. Trvoux E. Chryssikopoulos F. Franchi M. Luisi P. M. Kicovic 《Maturitas》1984,5(4):281-286
A multicentre study covering 69 post-menopausal or oophorectomized women was performed to determine whether Org OD 14 ((7, 17)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one) administered orally in a daily dose of 2.5 mg for 90 consecutive days induces endometrial proliferation. The treatment with Org OD 14 was continued in combination with 1 mg/day of lynestrenol from day 91 for 10 days to ascertain whether secretory transformation of the endometrium and subsequent withdrawal bleeding would occur. Endometrial biopsies were obtained before treatment and on day 91. The effects of Org OD 14 on vaginal mucosa and cervical mucus were also evaluated.
Org OD 14 did not display any effect on the endometrium in 56 of the study subjects (83.5%). Weak stimulation (initial proliferation) was seen in 11 of the subjects (16.4%) and withdrawal bleeding occurred in only 5 of these after cessation of the combined treatment with lynestrenol. However, moderate ‘oestrogenic’ effects on vaginal mucosa and cervical mucus were induced in all study subjects. 相似文献