Pathomorphological and CT-angiographical characteristics of coronary atherosclerotic plaques in cases of sudden cardiac death.

The goal of this study was to assess the localization and types of thrombosed plaques in cases of sudden cardiac death attributed to coronary artery disease and to evaluate possible correlations with body mass index (BMI) and increased heart weight. This retrospective study was performed on forensic cases for which the cause of death was attributed to coronary artery disease. A complete autopsy and a multi-phase postmortem computed tomography (CT) angiography (MPMCTA) were performed in all cases. Eighty-five cases were selected (mean age, 55.18 ± 11.04 years; 72 men and 13 women). MPMCTA performed prior to autopsy enabled an evaluation of coronary artery perfusion before dissection of the body and helped therefore to guide sampling for histology. An acute coronary thrombosis was found in 57 cases, which included plaque erosion in 26 cases (mean age, 46.73 ± 8.33 years) and rupture or intra-plaque hemorrhage in 31 cases (mean age, 58.23 ± 10.62 years). Erosions were most frequently found in the left anterior descending artery (61.5 %), while only 35.48 % of ruptures were observed in this artery. Chronic coronary pathology was considered as the main cause of death in 28 cases (mean age, 59.64 ± 9.47 years). Sixty-two of the cases (72.94 %) had a BMI in the overweight category (BMI ≥25), with the highest mean BMI in patients with chronic coronary pathology without acute thrombosis found at autopsy. The heart weight was above the predicted reference values in 52 cases (61.18 %). Our results are in accordance with previously published studies on the spatial distribution of vulnerable plaques. We observed a higher percentage of eroded plaques than previously reported. Patients with coronary erosions were significantly younger than those with plaque rupture or those without an acute coronary thrombosis (p values <0.0001). BMI and heart weight were significantly higher for cases without thrombosis in comparison with those with plaque rupture (p values 0.028 and 0.003, respectively). Our results indicating that increased BMI and overweight hearts are associated with chronic ischemic heart disease are compatible with clinical studies. Performing more postmortem studies on forensic autopsies, including modern radiological examinations with MPMCTA, can enhance the detection of vulnerable plaques in living patients and prevent sudden cardiac death.

Visiosta toimivaksi yritysverkostoksi –verkostoitumisprosessin tutkiminen ja tulevaisuuden toimintamallin rakentaminen Case: Imatran Seudun Koivukeskus

Tutkimuksen tarkoitus oli tutkia, miten case-verkosto Imatran Seudun Koivukeskus on syntynyt ja luoda sille sopiva tulevaisuuden toimintamalli. Tutkimuksessa hyödynnettiin käsiteanalyyttista ja konstruktiivista tutkimusotetta. Tutkimuksen tavoitteita olivat keskeisten käsitteiden määrittely; onnistuneiden ja epäonnistuneiden verkostoitumisesimerkkien kuvaaminen ja analysointi; case-verkoston esittely; case-verkoston historiallinen analyysi, sen toimintamallin tutkiminen ja vertaaminen esimerkkitapauksiin sekä case-verkoston tulevaisuuden kehitysnäkymien analysointi ja sille sopivan toimintamallin muodostaminen. Tutkielma koostui teoreettisesta osasta ja empiirisestä osasta. Teoriaosio käsitteli verkostoitumisen teoriaa. Tämä osio ja suoritetut teemahaastattelut loivat pohjan empiiriselle osuudelle ja toimintamallin muodostamiselle case-yritykselle. Tutkimuksen perusteella kriittisimmiksi case-verkoston tulevaisuuden toimintamallin osa-alueiksi osoittautuivat raaka-aineen saatavuus sekä avoimuus ja tiedonkulku verkostossa. Näiden lisäksi toimintamallissa tulee painottaa alihankinnan ja jatkojalostuksen lisäämistä, tutkimus- ja kehitystoimintaa sekä kuivaustoiminnan osaamistason kehittämistä.

Toimitusketjun kehittäminen logistiikkaintegraattorin avulla

Globaalissa taloudessa yritysten rakenteet ovat kehittyneet yhteistyöverkostoiksi, joissa yritykset pyrkivät keskittymään ydinosaamiseensa ja tuottamaan muut toiminnot yhteistyökumppaneilla. Nykyisin yhä suurempi osa myös logistisista toiminnoista tuotetaan kolmansilla osapuolilla. Logistiikan piirissä saavutettavat synergiaedut ovat suuret ja monet yritykset niitä ovat myös jo saavuttaneet. Menestyksekkäät esimerkit ulkoistamisista ja toisaalta kehittyvän tietotekniikan tuomat uudet toimintamahdollisuudet johtavat ulkoistamisen, 3PL toiminnan, entistäkin suurempaan suosioon. Ongelmaksi on yrityksille muodostunut yhteistyökumppaneiden suuri määrä. Kun ydinosaamisalueen ulkopuolisia tehtäviä on jaettu useille eri yritykselle, tulee yhteistyöverkoston hallinnasta haasteellinen tehtävä, ja siihen vaaditaan kalliita tietojärjestelmiä. Kustannusten säästö saattoi kuitenkin olla ulkoistaneen yrityksen motiivi! Kaiken lisäksi toimitusketjun hallinnan periaatteiden mukaisesti tiukka toimitusketjun sisäinen koordinointi on välttämättömyys arvoprosessin tehokkuuudelle. Tutkimuksen tarkoituksena on selvittää 4PL toimintamallin logiikka, sekä kuinka sitä voidaan käyttää ratkaisemaan 3PL toiminnan ongelmakohtia. Case osuudessa esitellään kahden haastateluin selvitetyn logistiikkaintegraattorin toiminta ja tarkastellaan niiden toiminnan pohjalta teoreettista mallia. Tutkimuksen toisena päätavoitteena on selvittää toimitusketjun hallinnan periaatteet kehitettäessä toimitusketjua sekä tutkia 4PL toimintamallia näiden teorioiden valossa. Tutkielmassa esitetään toimitusketjun hallinnan integraatiofilosofian mukaiset periaatteet, jossa integroidaan toimitusketjun 8 avainprosessia. Tutkimuksen tulokset osoittavat, että joint venture yrityksenä perustettavan logistiikkaintegraattorin käyttö toimitusketjussa voi parantaa ennenkaikkea koordinointiongelmia, pienentää logistisia kustannuksia, sekä tehokkaasti vähentää niitä ongelmia, joita kolmannen osapuolen palveluntarjoajien käyttö yritykselle aiheuttaa. Tutkimuksessa esitetään myös kuinka logistiikkaintegraattorin toimintaperiaatteita voidaan laajentaa arvoketjuintegraattoriksi ja kuinka se voi auttaa toimitusketjun avainprosessien integroinnissa, synergiaetujen hyödyntämisessä ja koko toimitusketjun tehokkaassa hallinnassa.

Ulkomaisen pk-yrityksen teollisuusinvestointi Suomeen, Case Pariwood Case Pariwood.

Kuukauden kuluttua tästä päivästä voidaan sanoa: 'Viime vuosisadalla maapallo kutistui merkittävästi, kulkuyhteydet paransivat ihmisten ja tavaroiden liikkuvuutta, mutta ennen kaikkea tietoliikenteessä tapahtui valtava kehitys.' Rahamarkkinoiden integroituessa pääomien transaktiokustannukset lähentyvät vähitellen nollaa, jolloin voidaan puhua suprajohtavasta kapitalismista (Kasvio et al.1999). Tässä tutkimuksessa osoitan, että myös pienet ja keskisuuret yritykset voivat tehdä onnistuneita suoria sijoituksia ulkomaille, Pariwoodin tapauksessa Suomeen. Suomen hyvät kuusitukkivarat, puun laatu ja saatavuus, ovat päätekijöitä tähän investointiin. Kun yrittäjien motivaatio on riittävän korkea ja heillä on aikaa ja sitkeyttä ideansa toteuttamiseen, tulos on onnistunut. Edullinen taloussuhdanne Euroopassa Pariwoodin markkina-alueella on edistänyt hanketta. Kuntien harjoittamalla elinkeinopolitiikalla on merkitystä ja kunnat ja valtiovalta voivat hankekohtaisella aktiivisuudellaan edesauttaa tätä kehitystä. Kyse on myös luottamuksesta. Pariwoodin tapauksessa itävaltalaiset omistajat perustelivat investointipäätöstä myös Suomen infrastruktuurilla ja viranomaisten kanssa hyvin sujuneella yhteistyöllä. Sijoitusten allokoinnissa on myös kyse työstä, työpaikkojen syntymisestä tai pysymisestä siellä, missä kustannukset ovat edulliset tai työntekijöiden ammattitaito täyttää investoijien vaatimukset. Ulkomaisissa suorissa sijoituksissa Suomeen tulee paitsi rahaa, myös uudenlaista teollisuutta ja osaamista. Korkean teknologian tuotantoa on myös puualalla. Ulkomaiset omistajat edustavat usein erilaista johtamiskulttuuria, kuin mihin Suomessa ollaan totuttu. Pariwoodin tapauksessa suuria ongelmia ei esiintynyt. Suomen EU-jäsenyydellä on ollut tätäkin hanketta edistävä vaikutus. Rahoitus on järjestynyt samoin periaattein kuin kansallisissa hankkeissa. Rahoitusneuvottelut kestivät hieman pidempään, noin vuoden. Lopputulokseen ovat tyytyväisiä omistajat, Parikkalan kunnan edustajat, työntekijät ja luotonantajat. Pariwood käy esimerkistä onnistuneesta ulkomaisesta teollisuusinvestoinnista Suomeen.

In-vivo brain neuroimaging provides a gateway for integrating biological and clinical biomarkers of Alzheimer's disease.

PURPOSE OF REVIEW: Only 5% of the Alzheimer's cases are explained by genetic mutations, whereas the remaining 95% are sporadic. The pathophysiological mechanisms underlying sporadic Alzheimer's disease are not well understood, suggesting a complex multifactorial cause. This review summarizes the recent findings on research aiming to show how biomarkers can be used for revealing the underlying mechanisms of preclinical stage Alzheimer's disease and help in their diagnosis. RECENT FINDINGS: The undisputed successful publicly accessible repositories provide longitudinal brain images, clinical, genetic and proteomic information of Alzheimer's disease. By combining with increasingly sophisticated data analysis methods, it is a great opportunity for searching new biomarkers. Innovative studies validated theoretical models of disease progression demonstrating the sequential ordering of well-established biomarkers. Novel observations shed light on the interaction between biomarkers to confirm that disease progression is related to multiple pathological factors. A typical example is the tau-associated neuronal toxicity that can be additionally potentiated by amyloid β peptides. To increase further the complexity, studies report specific impact of common genetic variants that can be traced from childhood through middle age up to the symptomatic onset of Alzheimer's disease. SUMMARY: The discovery of efficient therapies to prevent the disease or modify the progression of disease requires a more thorough understanding of the underlying biological processes. Neuroimaging, genetic and proteomic biomarkers for Alzheimer's disease are critically discussed and proposed to be included in clinical descriptions and diagnostic guidelines.

Decreasing Proportion of Recent Infections among Newly Diagnosed HIV-1 Cases in Switzerland, 2008 to 2013 Based on Line-Immunoassay-Based Algorithms.

BACKGROUND: HIV surveillance requires monitoring of new HIV diagnoses and differentiation of incident and older infections. In 2008, Switzerland implemented a system for monitoring incident HIV infections based on the results of a line immunoassay (Inno-Lia) mandatorily conducted for HIV confirmation and type differentiation (HIV-1, HIV-2) of all newly diagnosed patients. Based on this system, we assessed the proportion of incident HIV infection among newly diagnosed cases in Switzerland during 2008-2013. METHODS AND RESULTS: Inno-Lia antibody reaction patterns recorded in anonymous HIV notifications to the federal health authority were classified by 10 published algorithms into incident (up to 12 months) or older infections. Utilizing these data, annual incident infection estimates were obtained in two ways, (i) based on the diagnostic performance of the algorithms and utilizing the relationship 'incident = true incident + false incident', (ii) based on the window-periods of the algorithms and utilizing the relationship 'Prevalence = Incidence x Duration'. From 2008-2013, 3'851 HIV notifications were received. Adult HIV-1 infections amounted to 3'809 cases, and 3'636 of them (95.5%) contained Inno-Lia data. Incident infection totals calculated were similar for the performance- and window-based methods, amounting on average to 1'755 (95% confidence interval, 1588-1923) and 1'790 cases (95% CI, 1679-1900), respectively. More than half of these were among men who had sex with men. Both methods showed a continuous decline of annual incident infections 2008-2013, totaling -59.5% and -50.2%, respectively. The decline of incident infections continued even in 2012, when a 15% increase in HIV notifications had been observed. This increase was entirely due to older infections. Overall declines 2008-2013 were of similar extent among the major transmission groups. CONCLUSIONS: Inno-Lia based incident HIV-1 infection surveillance proved useful and reliable. It represents a free, additional public health benefit of the use of this relatively costly test for HIV confirmation and type differentiation.

Bevacizumab, Pemetrexed, and Cisplatin, or Bevacizumab and Erlotinib for Patients With Advanced Non-Small-Cell Lung Cancer Stratified by Epidermal Growth Factor Receptor Mutation: Phase II Trial SAKK19/09.

OBJECTIVE: The goal was to demonstrate that tailored therapy, according to tumor histology and epidermal growth factor receptor (EGFR) mutation status, and the introduction of novel drug combinations in the treatment of advanced non-small-cell lung cancer are promising for further investigation. METHODS: We conducted a multicenter phase II trial with mandatory EGFR testing and 2 strata. Patients with EGFR wild type received 4 cycles of bevacizumab, pemetrexed, and cisplatin, followed by maintenance with bevacizumab and pemetrexed until progression. Patients with EGFR mutations received bevacizumab and erlotinib until progression. Patients had computed tomography scans every 6 weeks and repeat biopsy at progression. The primary end point was progression-free survival (PFS) ≥ 35% at 6 months in stratum EGFR wild type; 77 patients were required to reach a power of 90% with an alpha of 5%. Secondary end points were median PFS, overall survival, best overall response rate (ORR), and tolerability. Further biomarkers and biopsy at progression were also evaluated. RESULTS: A total of 77 evaluable patients with EGFR wild type received an average of 9 cycles (range, 1-25). PFS at 6 months was 45.5%, median PFS was 6.9 months, overall survival was 12.1 months, and ORR was 62%. Kirsten rat sarcoma oncogene mutations and circulating vascular endothelial growth factor negatively correlated with survival, but thymidylate synthase expression did not. A total of 20 patients with EGFR mutations received an average of 16 cycles. PFS at 6 months was 70%, median PFS was 14 months, and ORR was 70%. Biopsy at progression was safe and successful in 71% of the cases. CONCLUSIONS: Both combination therapies were promising for further studies. Biopsy at progression was feasible and will be part of future SAKK studies to investigate molecular mechanisms of resistance.

Stafne bone cavity: a retrospective study of 11 cases

Objective: to describe the clinical and radiological characteristics of patients with Stafne bone cavity. Study design: a retrospective, observational study of 11 cases of Stafne bone cavity. After finding an imagine compatible with Stafne bone cavity in the Orthopantomograph® of 11 patients, a sialography of the mandibular gland was made in 3 cases, computerized tomography (CT) in 6 cases, and in 4 cases surgical intervention to confirm the diagnosis. Results: the average age was 51.5 years, predominantly males. The entity was diagnosed incidentally during a routine radiology in all cases. The sialography revealed glandular tissue within the defect, and the CT demonstrated the conservation of the lingual cortical and the peripheral origin of the lesion. Glandular tissue was found within the lesions of two of the patients who underwent surgery, and in the other two the cavity was empty. No progressive changes were found in any of the 11 cases. Conclusions: Stafne bone cavity was an incidental finding, presenting no evolutionary changes, and as such conservatory therapy based on periodic controls was indicated. Currently, complementary techniques such as CT are sufficient to establish a certain diagnosis.

Orofacial pain of cardiac origin: review literature and clinical cases

The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin. Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature. Study Design: Description of clinical cases and review of clinical cases. Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments.

Market Orientation in Rapidly Internationalizing Small Companies — Evidence from the Software Industry

For more than a decade, researchers have been aware of the increased pace of small-firm internationalization and the greater effect of these rapidly growing small businesses on the wealth, international trade, and job-creation opportunities of countries. Due to the small size of the home market, Finnish companies have been generally considered highly interested in internationalization. One particular domain in which rapid internationalization has been considered feasible is the global software business, with its knowledge-intensive nature and high growth potential. However, over time the failure rate of small entrepreneurial firms has remained especially high in high-technology markets. One of the reasons for this seems to lie in the fact that these companies are often formed by people with a strong technological background but limited competences in other areas. Further, research on the marketing capabilities of rapidly internationalizing high-tech firms has been scarce thus far. In addition, while there is much research on the first years of operations of rapidly internationalizing companies, it is not well known what becomes of them later on. Therefore, there is a need for more investigation into the managerial mindset, competences and decision-making in these small companies, especially from the perspective of how they acquire and exploit market knowledge, and enhance their networking capabilities in order to promote international expansion. The present study focuses on market orientation in small software firms that internationalize their operations rapidly in global software markets. It builds on qualitative data to illustrate how these companies develop their market-oriented product-market strategies during the process of increasing international commitment. It also shows how they manage their network relationships in order to be able to offer better customer service and to thrive in the fierce global competition. The study was conducted in the empirical context of Finnish small software companies, and the main data consists of interviews with top managers in these businesses. The interviews were designed to cover a minimum period of five years of the company's international operations, thus offering a retrospective in-depth perspective on market orientation, internationalization and partnerships in the given context. One particular focus is on less successfully internationalized software companies, and the challenges they face when approaching international markets. This study makes a significant contribution to the literature on market orientation for several reasons. First, building on data from the software industry, it clarifies the existing theory in the context of rapid internationalization and network relationships. Secondly, it provides a good body of evidence on market orientation in both successfully and less successfully internationalized companies, and identifies the key related differences between the two company groups. Thirdly, it highlights the importance of inter-firm networks in the rapid internationalization of small software firms, providing companies with important market knowledge and, in some cases, management challenges. Fourthly, this investigation clarifies market orientation in the context of different software-product strategies, thus, combining the perspectives of market orientation in both manufacturing and services. In sum, the results of the study are significant for both small software firms and public-policy makers since they shed light on the market-oriented managerial mindset and the market-information gathering and sharing processes that are needed in successful rapid internationalization.

Social factors related to the clinical severity of influenza cases in Spain during the A(H1N1)2009 virus pandemic

Background During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection. Methods We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models. Results Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87) Conclusions In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections.

Technology transfer at the periphery of the Mycenaean world: the cases of Mycenaean pottery found in central Macedonia (Greece) and the Plain of Sybaris (Italy)

The study of technology transfer in pottery production to the periphery of the Mycenaean world has been addressed by considering two different areas, southern Italy and central Macedonia. Technological features such as ceramic paste, decoration and firing have been determined for different ceramic groups established according to provenance criteria. The studies of technology and provenance have been performed following an archaeometric approach, using neutron activation analysis, petrographic analysis, X-ray diffraction and scanning electron microscopy. The results have revealed the existence of two different models. On the one hand, southern Italy seems to exhibit a more organized pottery production, which follows a Mycenaean-like technology, while in central Macedonia production is probably more varied, being based in part on the technology of the local tradition.

Successful long-term ambulatory norepinephrine infusions in a patient with pure autonomic failure.

We present a case study of a patient with pure autonomic failure who was successfully treated with ambulatory norepinephrine (NE) infusions over a 9-year-period of time before death occurred unexpectedly. Given this patient's response to the NE infusion treatment, we discuss the option of ambulatory NE infusions as a treatment for severe orthostatic hypotension that is refractory to common treatments.

Acute pulmonary hypertension caused by tumor embolism: a report of two cases.

Acute pulmonary hypertension leading to right ventricular failure and circulatory collapse is usually caused by thromboembolic obstruction of the pulmonary circulation. However, in rare instances, other causes can be associated with a similar clinical presentation. We present and discuss the clinical histories of two patients with acute right ventricular failure due to an atypical cause of pulmonary hypertension, disseminated pulmonary tumor embolism.

Successful Surgical Pulmonary Embolectomy for Massive Perinatal Embolism after Emergency Cesarean Section.

Pregnant women are exposed to an increased risk for developing pulmonary embolism (PE), a main cause for maternal mortality. Surgical pulmonary embolectomy is one important therapeutic and potential life-saving armamentarium, considering pregnancy as a relative contraindication for thrombolysis. We present a case of a 36-year-old woman with massive bilateral PE after emergent caesarean delivery, requiring reanimation by external heart massage. The onset of massive intrauterine bleeding contraindicated thrombolysis and emergency surgical pulmonary embolectomy, followed by a hysterectomy, were preformed successfully. Acute surgical pulmonary embolectomy may be an option in critically diseased high-risk patients, requiring a multiteam approach, and should be part of the therapeutic armamentarium of the attending cardiac surgeon.