Birth weight, weight change, and blood pressure during childhood and adolescence: a school-based multiple cohort study.

OBJECTIVE: We assessed the association between birth weight, weight change, and current blood pressure (BP) across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an island state in the African region. METHODS: Three cohorts were analyzed: 1004 children examined at age 5.5 and 9.1 years, 1886 children at 9.1 and 12.5, and 1575 children at 12.5 and 15.5, respectively. Birth and 1-year anthropometric data were gathered from medical files. The outcome was BP at age 5.5, 9.1, 12.5 or 15.5 years, respectively. Conditional linear regression analysis was used to estimate the relative contribution of changes in weight (expressed in z-score) during different age periods on BP. All analyses were adjusted for height. RESULTS: At all ages, current BP was strongly associated with current weight. Birth weight was not significantly associated with current BP. Upon adjustment for current weight, the association between birth weight and current BP tended to become negative. Conditional linear regression analyses indicated that changes in weight during successive age periods since birth contributed substantially to current BP at all ages. The strength of the association between weight change and current BP increased throughout successive age periods. CONCLUSION: Weight changes during any age period since birth have substantial impact on BP during childhood and adolescence, with BP being more responsive to recent than earlier weight changes.

Results of An International Study of Quantitative BCR/ABL Assays Using Defined RNA Samples

Molecular monitoring of BCR/ABL transcripts by real time quantitative reverse transcription PCR (qRT-PCR) is an essential technique for clinical management of patients with BCR/ABL-positive CML and ALL. Though quantitative BCR/ABL assays are performed in hundreds of laboratories worldwide, results among these laboratories cannot be reliably compared due to heterogeneity in test methods, data analysis, reporting, and lack of quantitative standards. Recent efforts towards standardization have been limited in scope. Aliquots of RNA were sent to clinical test centers worldwide in order to evaluate methods and reporting for e1a2, b2a2, and b3a2 transcript levels using their own qRT-PCR assays. Total RNA was isolated from tissue culture cells that expressed each of the different BCR/ABL transcripts. Serial log dilutions were prepared, ranging from 100 to 10-5, in RNA isolated from HL60 cells. Laboratories performed 5 independent qRT-PCR reactions for each sample type at each dilution. In addition, 15 qRT-PCR reactions of the 10-3 b3a2 RNA dilution were run to assess reproducibility within and between laboratories. Participants were asked to run the samples following their standard protocols and to report cycle threshold (Ct), quantitative values for BCR/ABL and housekeeping genes, and ratios of BCR/ABL to housekeeping genes for each sample RNA. Thirty-seven (n=37) participants have submitted qRT-PCR results for analysis (36, 37, and 34 labs generated data for b2a2, b3a2, and e1a2, respectively). The limit of detection for this study was defined as the lowest dilution that a Ct value could be detected for all 5 replicates. For b2a2, 15, 16, 4, and 1 lab(s) showed a limit of detection at the 10-5, 10-4, 10-3, and 10-2 dilutions, respectively. For b3a2, 20, 13, and 4 labs showed a limit of detection at the 10-5, 10-4, and 10-3 dilutions, respectively. For e1a2, 10, 21, 2, and 1 lab(s) showed a limit of detection at the 10-5, 10-4, 10-3, and 10-2 dilutions, respectively. Log %BCR/ABL ratio values provided a method for comparing results between the different laboratories for each BCR/ABL dilution series. Linear regression analysis revealed concordance among the majority of participant data over the 10-1 to 10-4 dilutions. The overall slope values showed comparable results among the majority of b2a2 (mean=0.939; median=0.9627; range (0.399 - 1.1872)), b3a2 (mean=0.925; median=0.922; range (0.625 - 1.140)), and e1a2 (mean=0.897; median=0.909; range (0.5174 - 1.138)) laboratory results (Fig. 1-3)). Thirty-four (n=34) out of the 37 laboratories reported Ct values for all 15 replicates and only those with a complete data set were included in the inter-lab calculations. Eleven laboratories either did not report their copy number data or used other reporting units such as nanograms or cell numbers; therefore, only 26 laboratories were included in the overall analysis of copy numbers. The median copy number was 348.4, with a range from 15.6 to 547,000 copies (approximately a 4.5 log difference); the median intra-lab %CV was 19.2% with a range from 4.2% to 82.6%. While our international performance evaluation using serially diluted RNA samples has reinforced the fact that heterogeneity exists among clinical laboratories, it has also demonstrated that performance within a laboratory is overall very consistent. Accordingly, the availability of defined BCR/ABL RNAs may facilitate the validation of all phases of quantitative BCR/ABL analysis and may be extremely useful as a tool for monitoring assay performance. Ongoing analyses of these materials, along with the development of additional control materials, may solidify consensus around their application in routine laboratory testing and possible integration in worldwide efforts to standardize quantitative BCR/ABL testing.

Simultaneous measurement of regional cerebral blood flow by perfusion CT and stable xenon CT: a validation study.

BACKGROUND AND PURPOSE: Knowledge of cerebral blood flow (CBF) alterations in cases of acute stroke could be valuable in the early management of these cases. Among imaging techniques affording evaluation of cerebral perfusion, perfusion CT studies involve sequential acquisition of cerebral CT sections obtained in an axial mode during the IV administration of iodinated contrast material. They are thus very easy to perform in emergency settings. Perfusion CT values of CBF have proved to be accurate in animals, and perfusion CT affords plausible values in humans. The purpose of this study was to validate perfusion CT studies of CBF by comparison with the results provided by stable xenon CT, which have been reported to be accurate, and to evaluate acquisition and processing modalities of CT data, notably the possible deconvolution methods and the selection of the reference artery. METHODS: Twelve stable xenon CT and perfusion CT cerebral examinations were performed within an interval of a few minutes in patients with various cerebrovascular diseases. CBF maps were obtained from perfusion CT data by deconvolution using singular value decomposition and least mean square methods. The CBF were compared with the stable xenon CT results in multiple regions of interest through linear regression analysis and bilateral t tests for matched variables. RESULTS: Linear regression analysis showed good correlation between perfusion CT and stable xenon CT CBF values (singular value decomposition method: R(2) = 0.79, slope = 0.87; least mean square method: R(2) = 0.67, slope = 0.83). Bilateral t tests for matched variables did not identify a significant difference between the two imaging methods (P >.1). Both deconvolution methods were equivalent (P >.1). The choice of the reference artery is a major concern and has a strong influence on the final perfusion CT CBF map. CONCLUSION: Perfusion CT studies of CBF achieved with adequate acquisition parameters and processing lead to accurate and reliable results.

Kaasun jakauma paineellisissa sulpunkäsittelylaitteissa

Työn tarkoituksena oli tutkia kuinka kaasukuplat jakautuvat sellususpensioon, kun prosessiolosuhteita muutetaan. Kuplien kokojakauman avulla pyritään kartoittamaan kuinka kaasukuplat pilkkoutuvat ja onko olemassa raja-arvoa, milloin tehon lisäys ei enää pilko sellususpensiossa olevia kuplia pienemmiksi. Jakaumien avulla voidaan mahdollisesti kehittää kaasunpoistoa. Työssä selvitettiin voidaanko kameratekniikkaa käyttää kuplakokojen määrittämiseen sellusulpusta. Läpinäkymätön sellumassa tarjoaa kuvaukselle haasteellisen ympäristön. Myöskään kirjallisuudessa ei vastaavaa menetelmää aikaisemmin oltu käytetty. Kuvatusta materiaalista laskettiin kuplien halkaisijat, joita pyrittiin tarkastelemaan tilastollisesti. Tilastollinen tarkastelu toi eroja mittauspisteiden välille. Kuplien halkaisijoiden perusteella mallinnettiin kuplakokoon vaikuttavat prosessisuureet lineaarisella regressioanalyysillä. Mallinnuksen perusteella saatiinvasteisiin vaikuttavat riippumattomat muuttujat ja niiden matemaattiset malliyhtälöt. Tuloksina saatiin selville, että kuplien kokojakaumissa on eroja sekoitussäiliön eri puolilla. Sekoitussäiliössä suurten kuplien suhteellinen osuus kasvaa kaasupitoisuuden ja sakeuden noustessa. Mallinnuksen tärkeimpänä tuloksena voidaan todeta, että sakeus ja kaasutilavuus vaikuttavat kuplakokoon kasvattavasti. Kierrosnopeuden kasvattaminen pienentää kuplakokoa. Visuaalisen informaation avulla on helpompi ymmärtää kuinka kuplat käyttäytyvät.

Three-Dimensional (3D) Microarchitecture Correlations with 2D Projection Image Gray-Level Variations Assessed by Trabecular Bone Score Using High-Resolution Computed Tomographic Acquisitions: Effects of Resolution and Noise.

The aim of the present study is to determine the level of correlation between the 3-dimensional (3D) characteristics of trabecular bone microarchitecture, as evaluated using microcomputed tomography (μCT) reconstruction, and trabecular bone score (TBS), as evaluated using 2D projection images directly derived from 3D μCT reconstruction (TBSμCT). Moreover, we have evaluated the effects of image degradation (resolution and noise) and X-ray energy of projection on these correlations. Thirty human cadaveric vertebrae were acquired on a microscanner at an isotropic resolution of 93μm. The 3D microarchitecture parameters were obtained using MicroView (GE Healthcare, Wauwatosa, MI). The 2D projections of these 3D models were generated using the Beer-Lambert law at different X-ray energies. Degradation of image resolution was simulated (from 93 to 1488μm). Relationships between 3D microarchitecture parameters and TBSμCT at different resolutions were evaluated using linear regression analysis. Significant correlations were observed between TBSμCT and 3D microarchitecture parameters, regardless of the resolution. Correlations were detected that were strongly to intermediately positive for connectivity density (0.711≤r(2)≤0.752) and trabecular number (0.584≤r(2)≤0.648) and negative for trabecular space (-0.407 ≤r(2)≤-0.491), up to a pixel size of 1023μm. In addition, TBSμCT values were strongly correlated between each other (0.77≤r(2)≤0.96). Study results show that the correlations between TBSμCT at 93μm and 3D microarchitecture parameters are weakly impacted by the degradation of image resolution and the presence of noise.

Cross-Sectional and Longitudinal Associations between Body Mass Index and Cardiometabolic Risk Factors in Adolescents in a Country of the African Region.

We assessed the association between several cardiometabolic risk factors (CRFs) (blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid, and glucose) in 390 young adults aged 19-20 years in Seychelles (Indian Ocean, Africa) and body mass index (BMI) measured either at the same time (cross-sectional analysis) or at the age of 12-15 years (longitudinal analysis). BMI tracked markedly between age of 12-15 and age of 19-20. BMI was strongly associated with all considered CRFs in both cross-sectional and longitudinal analyses, with some exceptions. Comparing overweight participants with those having a BMI below the age-specific median, the odds ratios for high blood pressure were 5.4/4.7 (male/female) cross-sectionally and 2.5/3.9 longitudinally (P < 0.05). Significant associations were also found for most other CRFs, with some exceptions. In linear regression analysis including both BMI at age of 12-15 and BMI at age of 19-20, only BMI at age of 19-20 remained significantly associated with most CRFs. We conclude that CRFs are predicted strongly by either current or past BMI levels in adolescents and young adults in this population. The observation that only current BMI remained associated with CRFs when including past and current levels together suggests that weight control at a later age may be effective in reducing CRFs in overweight children irrespective of past weight status.

Tutkimus- ja kehitysyhteistyön motiivit

Pro gradu -tutkielman tavoitteena on operationalisoida T&K- yhteistyön prosessimaista luonnetta, eli tarkemmin sanottuna analysoida T&K-yhteistyösuhteidenmuodostumista ja motiiveja. Tutkielman hypoteesit muodostettiin analysoimalla yrityksen teknologiastrategiaan perustuvia uuden tiedon tuonnin ja olemassa olevan tiedon hyväksikäytön oppimistavoitteita. Motivaatio T&K- yhteistyölle syntyy mahdollisuudesta T&K- projektien riskien jakamiseen. T&K- yhteistyön motiiveja analysoitiin transaktio- ja byrokratiahyötyjen, jotka pohjautuvat mittakaava- ja synergiaeduille, lähteitä arvioiden. Hypoteeseja testattiin 276 suomalaisen teollisuusyrityksen otoksella. Otoksen yrityksillä oliollut T&K- toimintaa. Otos perustuu kyselyyn, joka toteutettiin Lappeenrannan teknillisen yliopiston kauppatieteiden osastolla vuonna 2004. Hypoteeseja testattiin tilastollisilla menetelmillä; lineaarisella regressioanalyysillä, parillisten ja riippumattomien otosten t-testeillä. Validiteetti- ja multikollineaarisuusongelman todennäköisyydet on huomioitu. Hypoteesit vahvistuivat osittain. Teknologisella epävarmuudella ja monimutkaisuudella ei ole suoraa vaikutusta T&K- yhteistyön intensiivisyyteen. Teknologisella epävarmuudella on osittainen vaikutus teknologiastrategian valintaan. Yrityksen transaktio- ja byrokratiahyödyt riippuvat teknologisista kyvykkyyksistä. Vain korkean teknologian alan yritykset saavuttavat hyötyjä myös intensiivisesti T&K- yhteistyösuhteita koordinoimalla. Teknologiaintensiivisyyteen perustuvien erot perustuvat teknologisen tiedon luonteeseen toimialalla. Transaktiokustannusteorian mukainenkustannusten minimointi ja kompetenssiperusteisten teorioiden mukainen strategisointi selittävät komplementaarisesti T&K-yhteistyösuhteiden muodostumista ja yrityksen rajojen määräytymistä.

Pääomarakenteisiin vaikuttavat tekijät suomalaisissa pörssiyrityksissä

Tutkielman tavoitteena on selvittää lineaarisen regressioanalyysin avulla paneelidataa käyttäen suomalaisten pörssiyritysten pääomarakenteisiin vaikuttavat tekijät vuosina 1999-2004. Näiden tekijöiden avulla päätellään, mitä pääomarakenneteoriaa/-teorioita nämä yritykset noudattavat. Pääomarakenneteoriat voidaan jakaa kahteen luokkaan sen mukaan, pyritäänkö niissä optimaaliseen pääomarakenteeseen vai ei. Tradeoff- ja siihen liittyvässä agenttiteoriassa pyritään optimaaliseen pääomarakenteeseen. Tradeoff-teoriassa pääomarakenne valitaan punnitsemalla vieraan pääoman hyötyjä ja haittoja. Agenttiteoria on muuten samanlainen kuin tradeoff-teoria, mutta siinä otetaan lisäksi huomioon velan agenttikustannukset. Pecking order - ja ajoitusteoriassa ei pyritä optimaaliseen pääoma-rakenteeseen. Pecking order -teoriassa rahoitus valitaan hierarkian mukaan (tulorahoitus, vieras pääoma, välirahoitus, oma pääoma). Ajoitusteoriassa valitaan se rahoitusmuoto, jota on kannattavinta hankkia vallitsevassa markkinatilanteessa. Empiiristen tulosten mukaan velkaantumisaste riippuu positiivisesti riskistä, vakuudesta ja aineettomasta omaisuudesta. Velkaantumisaste riippuu negatiivisesti likviditeetistä, osaketuotoista ja kannattavuudesta. Osingoilla ei ole vaikutusta velkaantumisasteeseen. Toimialoista teollisuustuotteiden ja -palveluiden sekä perusteollisuuden aloilla on korkeammat velkaantumisasteet kuin muilla toimialoilla. Tulokset tukevat pääosin pecking order -teoriaa ja jonkin verran ajoitusteoriaa. Muut teoriat saavat vain vähäistä tukea.

The Effect of Family Ownership on Firm Performance: Empirical Evidence from Norway

Tutkimuksen tavoitteena on selvittää, onko perheomistajuus, eli yksityisomistus, kannattavampi omistusmuoto kuin institutionaalinen omistajuus ja, onko yrityksen iällä ja koolla vaikutusta perheyritysten menestymiseen. Aikaisempaan tutkimustietoon tukeutuen, tutkimuksen aluksi käydään myös läpi perheomistajuuteen yleisesti liitettyjä ominaispiirteitä sekä perheyritysten menestymistä verrattuna ei-perheyrityksiin. Empiirinen analyysi perheomistajuuden vaikutuksista yrityksen kannattavuuteen sekä yrityksen iän ja koon vaikutuksista perheyritysten menestymiseen toteutetaan kahden otoksen avulla, jotka koostuvat listaamattomista norjalaisista pienistä ja keskisuurista yrityksistä (pk-yrityksistä). Näin ollen satunnaisotos ja päätoimialaotos, johon listaamattomat pk-yritykset on valittu satunnaisesti Norjan tärkeimmiltä toimialoilta, analysoidaan erikseen. Analyysi toteutetaan käyttäen lineaarista regressioanalyysia. Vaikka satunnaisotoksen perusteella perheyritykset eivät näytä olevan ei-perheyrityksiä kannattavampia, päätoimialaotos osoittaa, että listaamattomissa pk-yrityksissä perhe- eli yksityisomistajuus on merkittävästi institutionaalista omistajuutta kannattavampi omistusmuoto. Eritoten nuoret ja pienet yritykset vastaavat perheyritysten paremmasta kannattavuudesta.

Welding time models for cost calculations in the early stages of the design process

It is generally accepted that between 70 and 80% of manufacturing costs can be attributed to design. Nevertheless, it is difficult for the designer to estimate manufacturing costs accurately, especially when alternative constructions are compared at the conceptual design phase, because of the lack of cost information and appropriate tools. In general, previous reports concerning optimisation of a welded structure have used the mass of the product as the basis for the cost comparison. However, it can easily be shown using a simple example that the use of product mass as the sole manufacturing cost estimator is unsatisfactory. This study describes a method of formulating welding time models for cost calculation, and presents the results of the models for particular sections, based on typical costs in Finland. This was achieved by collecting information concerning welded products from different companies. The data included 71 different welded assemblies taken from the mechanical engineering and construction industries. The welded assemblies contained in total 1 589 welded parts, 4 257 separate welds, and a total welded length of 3 188 metres. The data were modelled for statistical calculations, and models of welding time were derived by using linear regression analysis. Themodels were tested by using appropriate statistical methods, and were found to be accurate. General welding time models have been developed, valid for welding in Finland, as well as specific, more accurate models for particular companies. The models are presented in such a form that they can be used easily by a designer, enabling the cost calculation to be automated.

Ash Particle Erosion on Steam Boiler Convective Section

In this study, equations for the calculation of erosion wear caused by ash particles on convective heat exchanger tubes of steam boilers are presented. Anew, three-dimensional test arrangement was used in the testing of the erosion wear of convective heat exchanger tubes of steam boilers. When using the sleeve-method, three different tube materials and three tube constructions could be tested. New results were obtained from the analyses. The main mechanisms of erosionwear phenomena and erosion wear as a function of collision conditions and material properties have been studied. Properties of fossil fuels have also been presented. When burning solid fuels, such as pulverized coal and peat in steam boilers, most of the ash is entrained by the flue gas in the furnace. In bubbling andcirculating fluidized bed boilers, particle concentration in the flue gas is high because of bed material entrained in the flue gas. Hard particles, such as sharp edged quartz crystals, cause erosion wear when colliding on convective heat exchanger tubes and on the rear wall of the steam boiler. The most important ways to reduce erosion wear in steam boilers is to keep the velocity of the flue gas moderate and prevent channelling of the ash flow in a certain part of the cross section of the flue gas channel, especially near the back wall. One can do this by constructing the boiler with the following components. Screen plates can beused to make the velocity and ash flow distributions more even at the cross-section of the channel. Shield plates and plate type constructions in superheaters can also be used. Erosion testing was conducted with three types of tube constructions: a one tube row, an inline tube bank with six tube rows, and a staggered tube bank with six tube rows. Three flow velocities and two particle concentrations were used in the tests, which were carried out at room temperature. Three particle materials were used: quartz, coal ash and peat ash particles. Mass loss, diameter loss and wall thickness loss measurements of the test sleeves were taken. Erosion wear as a function of flow conditions, tube material and tube construction was analyzed by single-variable linear regression analysis. In developing the erosion wear calculation equations, multi-variable linear regression analysis was used. In the staggered tube bank, erosion wear had a maximum value in a tube row 2 and a local maximum in row 5. In rows 3, 4 and 6, the erosion rate was low. On the other hand, in the in-line tube bank the minimum erosion rate occurred in tube row 2 and in further rows the erosion had an increasing value, so that in a six row tube bank, the maximum value occurred in row 6.

The effect of information and communication technology on global paper consumption

The objective of this thesis is to find out how information and communication technology affects the global consumption of printing and writing papers. Another objective is to find out, whether there are differences between paper grades in these effects. The empirical analysis is conducted by linear regression analysis using three sets of country-level panel data from 1990-2006. Data set of newsprint contains 95 countries, data set of uncoated woodfree paper 61 countries and data set of coated mechanical paper 42 countries. The material is based on paper consumption data of RISI’s Industry Statistics Database and on the information and communication technology data of GMID-database. Results indicate that number of Internet users has statistically significant negative effect on the consumption of newsprint and on the consumption of coated mechanical paper and number of mobile telephone users has positive effect on the consumptions of these papers. Results also indicate that information and communication technologies have only small effect on consumption of uncoated woodfree paper or no significant effect at all, but these results are more uncertain to some extent.

Kineettinen tarkastelu keskisakeusalueella toimivalle happivaiheelle

Työn tavoitteena oli tarkastella keskisakeudessa toimivan happidelignifioinnin kinetiikkaa ja vertailla sitä olemassa olevien kineettisten tutkimuksien kanssa. Lisäksi tutkittiin kuinka happivaiheen suodos vaikuttaa delignifiointiasteeseen sekä selektiivisyyteen. Työn kirjallisuusosassa perehdyttiin happidelignifioinnin kineettisiin malleihin, jotka on kehitetty ennustamaan alkalin, paineen, lämpötilan ja ajan vaikutusta ligniinin poistumiselle sekä hiilihydraattiketjujen katkeilulle. Delignifioituminen on nopeaa ensimmäisen kymmenen minuutin aikana ja hidastuu jäännösdelignifiointivaiheessa. Laboratoriotutkimuksissa selvitettiin kuinka prosessimuuttujat vaikuttavat kappaluvun ja viskositeetin muutokseen. Tuloksia tarkasteltiin lineaarisella regressioanalyysillä, jonka avulla muuttujien vaikutukset saadaan selkeästi esille. Happivaiheen ensimmäisessä vaiheessa suurin vaikutus delignifiointiasteeseen sekä viskositeetin alenemiseen on alkaliannoksella. Pienillä hapen annostuksella saavutettiin hyvä selektiivisyys, suurillakin alkaliannoksilla. Lämpötilan vaikutus on lähes olematon, kun paine on pieni. Kun paine kasvaa, kasvaa myös lämpötilan vaikutus delignifiointiasteeseen. Hiilihydraattien depolymerisoituminen lisääntyy lämpötilan kasvaessa lähes lineaarisesti, riippumatta paineesta. Hyvä loppuselektiivisyys saavutetaan kun ensimmäisen vaiheen selektiivisyys on hyvä. Ensimmäisessä vaiheessa saavutettiin hyvä selektiivisyys, kun alkali ei pääse kulumaan loppuun eikä delignifioituminen jatku liian pitkälle. Toisessa vaiheessa selektiivisyys säilyy parhaiten, kun lisättävä alkaliannos on pieni. Lämpötila ja paine vaikuttavat alkaliannokseen verrattuna hyvin vähän loppuselektiivisyyteen.

Suolan pesu ja liuottimen strippaus selluloosaeetteristä

Työssä tutkittiin suolan pesua ja liuottimen strippausta selluloosaeetteristä. Työn tavoitteena oli tutkia erään selluloosaeetterin ominaisuuksien vaikutusta pesuun ja strippaukseen. Strippauksesta selvitettiin pääasiallisesti alipaineen ja lämpötilan vaikutusta tarvittavaan höyrymäärään. Työn kirjallisuusosassa tarkasteltiin selluloosaeetterin valmistuksen teoriaa, pesu- ja strippausprosesseihin vaikuttavia muuttujia sekä erilaisia pesu- ja strippausprosesseihin soveltuvia laitteita. Kokeet suoritettiin pilotlaitoksellaja kahdella tuotantolinjalla. Pilotlaitos oli panosprosessi ja tuotantolinjat olivat jatkuvatoimisia prosesseja. Kokeiden analyysitulokset käsiteltiin lineaarisella regressioanalyysillä. Analyysitulosten perusteella todettiin strippausalipaineen kasvun ja -lämpötilan noston lisäävän tarvittavaa höyrymäärää strippauksessa. Myös stripattavan selluloosaeetterin kosteuspitoisuuden kasvun havaittiin lisäävän tarvittavaa höyrymäärää strippauksessa.

Prediction of Post-Weaning Fibrinogen Status during Cardiopulmonary Bypass: An Observational Study in 110 Patients.

BACKGROUND: After cardiac surgery with cardiopulmonary bypass (CPB), acquired coagulopathy often leads to post-CPB bleeding. Though multifactorial in origin, this coagulopathy is often aggravated by deficient fibrinogen levels. OBJECTIVE: To assess whether laboratory and thrombelastometric testing on CPB can predict plasma fibrinogen immediately after CPB weaning. PATIENTS / METHODS: This prospective study in 110 patients undergoing major cardiovascular surgery at risk of post-CPB bleeding compares fibrinogen level (Clauss method) and function (fibrin-specific thrombelastometry) in order to study the predictability of their course early after termination of CPB. Linear regression analysis and receiver operating characteristics were used to determine correlations and predictive accuracy. RESULTS: Quantitative estimation of post-CPB Clauss fibrinogen from on-CPB fibrinogen was feasible with small bias (+0.19 g/l), but with poor precision and a percentage of error >30%. A clinically useful alternative approach was developed by using on-CPB A10 to predict a Clauss fibrinogen range of interest instead of a discrete level. An on-CPB A10 ≤10 mm identified patients with a post-CPB Clauss fibrinogen of ≤1.5 g/l with a sensitivity of 0.99 and a positive predictive value of 0.60; it also identified those without a post-CPB Clauss fibrinogen <2.0 g/l with a specificity of 0.83. CONCLUSIONS: When measured on CPB prior to weaning, a FIBTEM A10 ≤10 mm is an early alert for post-CPB fibrinogen levels below or within the substitution range (1.5-2.0 g/l) recommended in case of post-CPB coagulopathic bleeding. This helps to minimize the delay to data-based hemostatic management after weaning from CPB.