A. Yli-hankala - Academia.edu (original) (raw)

Papers by A. Yli-hankala

stimulus of ulnar nerve as a predictor of heart rate

Acta Anaesthesiologica Scandinavica, 2017

BMC Genomics, 2015

Background: Whole genome sequencing (WGS) of Cryptosporidium spp. has previously relied on propag... more Background: Whole genome sequencing (WGS) of Cryptosporidium spp. has previously relied on propagation of the parasite in animals to generate enough oocysts from which to extract DNA of sufficient quantity and purity for analysis. We have developed and validated a method for preparation of genomic Cryptosporidium DNA suitable for WGS directly from human stool samples and used it to generate 10 high-quality whole Cryptosporidium genome assemblies. Our method uses a combination of salt flotation, immunomagnetic separation (IMS), and surface sterilisation of oocysts prior to DNA extraction, with subsequent use of the transposome-based Nextera XT kit to generate libraries for sequencing on Illumina platforms. IMS was found to be superior to caesium chloride density centrifugation for purification of oocysts from small volume stool samples and for reducing levels of contaminant DNA. Results: The IMS-based method was used initially to sequence whole genomes of Cryptosporidium hominis gp60 subtype IbA10G2 and Cryptosporidium parvum gp60 subtype IIaA19G1R2 from small amounts of stool left over from diagnostic testing of clinical cases of cryptosporidiosis. The C. parvum isolate was sequenced to a mean depth of 51.8X with reads covering 100 % of the bases of the C. parvum Iowa II reference genome (Bioproject PRJNA 15586), while the C. hominis isolate was sequenced to a mean depth of 34.7X with reads covering 98 % of the bases of the C. hominis TU502 v1 reference genome (Bioproject PRJNA 15585). The method was then applied to a further 17 stools, successfully generating another eight new whole genome sequences, of which two were C. hominis (gp60 subtypes IbA10G2 and IaA14R3) and six C. parvum (gp60 subtypes IIaA15G2R1 from three samples, and one each of IIaA17G1R1, IIaA18G2R1, and IIdA22G1), demonstrating the utility of this method to sequence Cryptosporidium genomes directly from clinical samples. This development is especially important as it reduces the requirement to propagate Cryptosporidium oocysts in animal models prior to genome sequencing. Conclusion: This represents the first report of high-quality whole genome sequencing of Cryptosporidium isolates prepared directly from human stool samples.

Memory and Awareness in Anaesthesia IV - Proceedings of the Fourth International Symposium, 2000

Annales chirurgiae et gynaecologiae, 1996

The effects of dextran on the antithrombin (AT) III activity and blood coagulation, evaluated wit... more The effects of dextran on the antithrombin (AT) III activity and blood coagulation, evaluated with thromboelastography, were investigated in 26 patients (anaesthesia risk class I or II) scheduled for minor surgery under general anaesthesia. In the Dextran group the patients were infused first with dextran 7 ml/kg, then with Ringer's acetate. In the Ringer group, the patients received only Ringer's acetate. In the recovery room fluid therapy was continued with 5% dextrose in water until the first postoperative day. Blood loss and fluid replacement were comparable in the groups. Haematocrit (Hcr) decreased significantly in the Dextran group, and the platelet count decreased in both groups during surgery. The median baseline AT III values were similar in the study groups. In the recovery room, the median AT III value was lower in the Dextran than in the Ringer group, 78% and 92%, respectively (P < 0.05). By the following day, the AT III values had returned near the initial l...

Journal of Internal Medicine, 2006

Bystander mouthto-mouth ventilation and regurgitation during cardiopulmonary resuscitation.

European Journal of Anaesthesiology, 2007

Material and methods: 50 resident doctors took part in a 2-phase evaluation. In Phase-1 we asked ... more Material and methods: 50 resident doctors took part in a 2-phase evaluation. In Phase-1 we asked participants to make the diagnosis of acute ischaemia using a set of 8 ECG printouts on the basis of ST elevation or depression. They also had to indicate their diagnostic certainty on a scale of 0-4 (0 ϭ lowest, 4 ϭ highest). This methodology was similar to that used by previous investigators 1. In Phase-2 they reviewed a second set of 8 ECGs, but they also had access to the new imaging monitor to help them reach a diagnosis. The new monitor could recall any of the 8 ECG's which were stored as electronic records. Two specialists marked the diagnosis made by participants in a scale of 0-2, and the aggregated score for all ECGs was labelled Diagnostic Proficiency score. The time to complete the test was also noted in both phases. Results: Diagnostic Proficiency scores and Certainty scores (Median value with 25th-75th percentile) were calculated for both Phases. We compared data from the two phases to establish effectiveness of the new ECG monitor as an aid to doctors. Using the new imaging ECG monitor, doctors increased their median Diagnostic Proficiency from 50% to 100% (P Ͻ 0.001); while their Certainty increased from 65% to 80% (P Ͻ 0.001). The average time taken to reach diagnosis dropped from 15 minutes to 9 minutes (P Ͻ 0.001). References:

Acta Anaesthesiologica Scandinavica, 1990

The effect of N,O on EEG during halothane and isoflurane anaesthesia was studied in 24 elective-s... more The effect of N,O on EEG during halothane and isoflurane anaesthesia was studied in 24 elective-surgery patients. The total EEG power and various power bands were analysed with fast Fourier transform power spectra. Anaesthesia was induced by mask. EEG analysis was performed from the data collected before induction and during steady-state halothane and isoflurane anaesthesia with and without N,O. In both halothane and isoflurane anaesthesia, N,O had a significant effect on EEG. Alpha-and beta-range EEG power and total power decreased during N,O in both groups. Delta-and theta-range power increased during N,O in the halothane group. The study shows that the effect of nitrous oxide should be taken into consideration when EEG is being studied or monitored during anaesthesia.

Acta Anaesthesiologica Scandinavica, 1995

The T-wave amplitude of ECG is thought to reflect the sympathetic tone of the heart but anaesthes... more The T-wave amplitude of ECG is thought to reflect the sympathetic tone of the heart but anaesthesia studies on this topic are rare. Haemodynamic and ECG T-wave amplitude changes were studied during induction of anaesthesia in 24 ASA I-II patients. Twelve patients were given alfentanil 30 micrograms kg-1 at induction while physiologic saline was given to the rest (control). Thiopentone was then administered at the rate of 5 mg s-1 until eyelash reflex disappeared. Vecuronium 0.1 mg kg-1 was given thereafter. No anticholinergics were used. The lungs were ventilated with 40% oxygen in air. Haemodynamic parameters and T-wave amplitude were measured before induction, before intubation, 30 s, 3 min and 5 min after intubation. A significantly higher amount of thiopentone was needed to abolish the eyelash reflex in the control group than in the alfentanil group (P < 0.001). There were no changes in heart rate (HR) in the alfentanil group during the trial. Systolic and diastolic arterial pressures (SAP and DAP) were continuously below the preinduction levels in the alfentanil group. After baseline HR, SAP and DAP were significantly higher in the control group than in the alfentanil group at each data point. T-wave amplitude flattened significantly (P < 0.001) after intubation in the control group while no significant changes were seen in the alfentanil group. T-wave flattening correlated to the increases in HR (P < 0.01) and SAP (P < 0.01). Three control patients with flattened T-wave had a transient bigeminia period after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Anaesthesiologica Scandinavica, 1994

A 31-yr male with insulin dependent diabetes mellitus for 20 years underwent general anaesthesia ... more A 31-yr male with insulin dependent diabetes mellitus for 20 years underwent general anaesthesia for renal transplantation. During transfer from operating theatre to ICU he developed bradycardia advancing to ventricular fibrillation and had to be resuscitated. Bradycardia did not respond to atropine. Postoperative autonomic nervous function tests showed advanced autonomic neuropathy. He was found to have constantly prolonged QTc interval in his pre- and postoperative ECGs (462-503 ms). Prolongation of QTc interval could be used as a valuable predictor of postoperative cardiac complications in diabetic patients with autonomic neuropathy.

Acta Anaesthesiologica Scandinavica, 1993

INTRODUCTION A wealth of evidence now documents that the brain may still process sensory informat... more INTRODUCTION A wealth of evidence now documents that the brain may still process sensory information during presumably adequate general anesthesia (1). The incidence of conscious awareness with postoperative recall is estimated at 1% during general surgery but may rise to 25% or greater during cardiopulmonary bypass, obstetrical or trauma surgery (2). Thus, detection and prevention of periods of inadequate anesthesia are more than academic issues they have become vital to the daily practice of clinical anesthesia. Since the advent of modern anesthetic techniques, patient movement has become established as the gold-standard indicator of inadequate anesthesia. However, the widespread use of neuromuscular blocking drugs often blunts or eliminates the responsiveness of skeletal muscles, regardless of the adequacy of anesthesia. Therefore, autonomic hernodynamic measures are now used universally as (nearly) continuous objective indices of anesthetic adequacy, despite the many reports documentingtheir unreliability (3). For the past decade our group has successfully employed quantitative electromyography (EMG) of the upper facial muscles to detect periods of inadequate anesthesia (4). This has been possible, in part, because these muscles are quite resistant to the effects of moderate doses of neuromuscular blockers (5). Meanwhile others have advocated simple quantitative EEG measures (6) or middle latency auditory evoked potential amplitude (7) as objective indices of anesthetic effect. Thus, the purpose of this study was to compare the sensitivity and reliability of these various methods for detecting patient responsiveness at the termination of general anesthesia.

2018 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI), 2018

Wrist photoplethysmography (PPG) allows unobtrusive monitoring of the heart rate (HR). PPG is aff... more Wrist photoplethysmography (PPG) allows unobtrusive monitoring of the heart rate (HR). PPG is affected by the capillary blood perfusion and the pumping function of the heart, which generally deteriorate with age and due to presence of cardiac arrhythmia. The performance of wrist PPG in monitoring beat-to-beat HR in older patients with arrhythmia has not been reported earlier. We monitored PPG from wrist in 18 patients recovering from surgery in the post anesthesia care unit, and evaluated the inter-beat interval (IBI) detection accuracy against ECG based R-to-R intervals (RRI). Nine subjects had sinus rhythm (SR, 68.0y ± 10.2y, 6 males) and nine subjects had atrial fibrillation (AF, 71.3y ± 7.8y, 4 males) during the recording. For the SR group, 99.44% of the beats were correctly identified, 2.39% extra beats were detected, and the mean absolute error (MAE) was 7.34 ms. For the AF group, 97.49% of the heartbeats were correctly identified, 2.26% extra beats were detected, and the MAE was 14.31 ms. IBI from the PPG were hence in close agreement with the ECG reference in both groups. The results suggest that wrist PPG provides a comfortable alternative to ECG and can be used for long-term monitoring and screening of AF episodes.

Methods of Information in Medicine, 1994

A non-parametric method is presented for modelling nonlinear dynamic mechanisms of respiratory si... more A non-parametric method is presented for modelling nonlinear dynamic mechanisms of respiratory sinus arrhythmia (RSA) in anesthesia caused by positive pressure ventilation. RR interval sequences are shown with Tsay's linearity test to contain both short-term and long-term nonlinear components, which cannot completely be modelled with optimal linear methods. The nonlinear approach is based on Wiener's theory for broad-band random input signal. The input-output model is formed for tracheal pressure and RR interval sequence. Second-order and third-order nonlinearities in RSA fluctuation are found and demonstrated.

Acta anaesthesiologica Scandinavica, 2014

Post-operative pain continues to be a major problem. Some previous studies have suggested that pa... more Post-operative pain continues to be a major problem. Some previous studies have suggested that patients anaesthetised with propofol have less pain after surgery than those anesthetised with volatiles. However, the results of previous studies are conflicting. We designed a large-scale trial to study, whether propofol or sevoflurane is more analgesic than the other. We measured opioid consumption in the acute post-operative phase after laparoscopic hysterectomy. In a randomised, prospective single-blind trial, we evaluated the consumption of oxycodone and pain intensity in 148 women for 20 h after laparoscopic hysterectomy under propofol or sevoflurane anaesthesia. The primary endpoint was the cumulative amount of oxycodone consumed. Secondary endpoints were pain scores [numeric rating scale (NRS)] at rest and with coughing, severity of nausea and state of sedation. The consumption of oxycodone and the NRS pain scores did not differ between the groups. The oxycodone consumed during fi...

Journal of Neurosurgical Anesthesiology, 1994

Intensive Care Medicine, 2006

European Journal of Anaesthesiology, 2000

European Journal of Anaesthesiology, 2011

Monitoring: Equipment and Computers the measured values(1), and it depends on the type of anaesth... more Monitoring: Equipment and Computers the measured values(1), and it depends on the type of anaesthesia. Our objective was to compare BIS values of the new BIS VISTA Monitoring System(Aspect Medical Systems, Norwood,MA) simultaneously measured from both sides of the head in the same patient during anaesthesia with 2% sevoflurane in 30% oxygen(Sevo group) and with propofol-70% nitrous oxide(Propo group). Materials and Methods: This randomized, prospective, comparative, observational study was approved by the local ethics commit tee. It enrolled 99 patients older than 18 years scheduled for elective surgery. Patients were excluded if they had a history of stroke, dementia, organic brain disease or carotid bruit. Two BIS Quatro® electrode strips from BIS VISTA® were placed on each side of their forehead. The clocks on both monitors were synchronized before each case to ensure a time dif ference of < 1second. BIS values generated by both sensors were downloaded for analysis to laptop computers from the induction until emergence from anesthesia. 47 subjects per group were considered necessary to dif ferentiate a bias of 3 point with an alfa and beta error of 0,05. Bland-Altman tests of agreement and bias were used. Bias dif ferences were compared with the student's t test. Chi square was used to compare proportions. Results and Discussion: Patients characteristics were similar. There were no bias(0,0,-0,6) between the BIS VISTA monitors in both groups indicating no clinical significant tendency for one side to produce a dif ferent measurement than the other. The dashed line shows the 95% limits of agreement for the lef t vs right-sided BIS values(fig. 1). These limits with BIS VISTA were smaller than previous(1) and suggest a BISxp® improvement. Conclusion: With both anaesthetic techiques, bias and limits of agreement were similar. [Bland-Altman analysis in propo and sevo groups] References: