TIINA UUETOA - Academia.edu (original) (raw)

Papers by TIINA UUETOA

2017 IEEE International Symposium on Medical Measurements and Applications (MeMeA), 2017

The central aortic pressure (CAP) is traditionally measured using a pressure sensor inserted into... more The central aortic pressure (CAP) is traditionally measured using a pressure sensor inserted into aorta. This invasive procedure is costly and can lead to complications. Therefore, attention is paid to the development of non-invasive methods. Tonometry sensors are mostly used for getting the primary pressure information non-invasively from the radial artery. Authors of the paper introduced a method of electrical bioimpedance (EBI) measurements on the radial artery to create a more robust method than tonometry. The main attention is paid on the synthesis of transfer functions connecting the central aortic and radial blood pressure curves. Finally it is concluded that the bioimpedance sensing method is at least a useful complementary component to the tonometry or can even replace it in the future developments.

Taust ja eesmark. Hinnata virvendusarutmia tusistuste ennetamiseks kasutatavate uute suukaudsete ... more Taust ja eesmark. Hinnata virvendusarutmia tusistuste ennetamiseks kasutatavate uute suukaudsete antikoagulantide – dabigatraani ja rivaroksabaani – kulutohusust ja eelarvemoju vorrelduna standardse varfariinraviga. Artikkel tugineb TU tervishoiu instituudis koostatud tervisetehnoloogiate hindamise raportile. Metoodika. Markovi simulatsioonimudeli ja eelarve moju analuusiga hinnati 65aastaste virvendusarutmiaga patsientide hupoteetilise kohordi tervisetulemeid ja ravikulusid eluea perspektiivis. Ravistrateegiatest vorreldi dabigatraani ja rivaroksabaani raviskeeme varfariinraviga, et oleks kaetud sihtruhma ravivajadus. Tulemused. Antikoagulantravi voib pikendada kvaliteetset eluiga 0,83–1,2 aasta vorra, sh lisanduks dabigatraaniga taiendavalt 0,37 kvaliteetset eluaastat (QALYt, ingl qualityadjusted life year) ja rivaroksabaaniga 0,23 QALYt patsiendi kohta vorreldes varfariinraviga. Lisanduva QALY maksumuseks kujuneb dabigatraani kasutamisel 20 696 eurot ning rivaroksabaani kasutamis...

Statiinravi on juba monda aega olnud kardiovaskulaarsete haiguste ravi ja preventsiooni oluline k... more Statiinravi on juba monda aega olnud kardiovaskulaarsete haiguste ravi ja preventsiooni oluline komponent, vahendades sudamepuudulikkusega haigetel oksudatiivset stressi ja poletikuseisundit ning parandades endoteeli funktsiooni. Statiinide pleiotroopsete toimete tottu voivad nad mojusad olla nii isheemilise kui ka mitteisheemilise geneesiga sudamepuudulikkusega haigetel. Statiinravi efekt on vahene kaugelearenenud sudamepuudulikkuse ja neerupuudulikkuse korral. Kaesolevas ulevaateartiklis on vaatluse alla voetud eelkoige viimase aasta jooksul publitseeritud andmed statiinravi toime ja kliinilise efektiivsuse kohta. Uute andmete valguses on selgemad mitmed statiinravi aspektid, aga ilmnenud on ka uued edasist uurimist vajavad probleemid (nt statiin kombinatsioonis esetimiibiga). Eesti Arst 2008; 87(12):938−943

Studies in health technology and informatics, 2013

The paper presents a non-invasive method and system for a long-term and continuous monitoring of ... more The paper presents a non-invasive method and system for a long-term and continuous monitoring of the central aortic pressure (CAP) waveform and the augmentation index (AI). The CAP curve is estimated from the measured radial electrical bio-impedance (EBI) using spectral domain transfer functions (TF), which are established on the basis of data analysis during clinical experiments. Experiments were carried out on 3 volunteers by now. During the experiment, a 0.5 mg sublingual nitroglycerin tablet was administrated to each volunteer. Both, the reconstructed CAP curve and the AI have very good correlation with the results obtained by the SphygmoCor system. But, in opposite to the traditional tonometry based CAP curve and AI estimation methods, the proposed one is more convenient to use and allows continuous and long-term personalized monitoring of the CAP curve and of the AI.

JAMA, 2021

Importance There is limited evidence on the benefits of sacubitril/valsartan vs broader renin ang... more Importance There is limited evidence on the benefits of sacubitril/valsartan vs broader renin angiotensin system inhibitor background therapy on surrogate outcome markers, 6-minute walk distance, and quality of life in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction (LVEF >40%). Objective To evaluate the effect of sacubitril/valsartan on N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, 6-minute walk distance, and quality of life vs background medication-based individualized comparators in patients with chronic heart failure and LVEF of more than 40%. Design, Setting, and Participants A 24-week, randomized, double-blind, parallel group clinical trial (August 2017-October 2019). Of 4632 patients screened at 396 centers in 32 countries, 2572 patients with heart failure, LVEF of more than 40%, elevated NT-proBNP levels, structural heart disease, and reduced quality of life were enrolled (last follow-up, October 28, 2019). Interventions Patients were randomized 1:1 either to sacubitril/valsartan (n = 1286) or to background medication-based individualized comparator (n = 1286), ie, enalapril, valsartan, or placebo stratified by prior use of a renin angiotensin system inhibitor. Main Outcomes and Measures Primary end points were change from baseline in plasma NT-proBNP level at week 12 and in the 6-minute walk distance at week 24. Secondary end points were change from baseline in quality of life measures and New York Heart Association (NYHA) class at 24 weeks. Results Among 2572 randomized patients (mean age, 72.6 years [SD, 8.5 years]; 1301 women [50.7%]), 2240 (87.1%) completed the trial. At baseline, the median NT-proBNP levels were 786 pg/mL in the sacubitril/valsartan group and 760 pg/mL in the comparator group. After 12 weeks, patients in the sacubitril/valsartan group (adjusted geometric mean ratio to baseline, 0.82 pg/mL) had a significantly greater reduction in NT-proBNP levels than did those in the comparator group (adjusted geometric mean ratio to baseline, 0.98 pg/mL) with an adjusted geometric mean ratio of 0.84 (95% CI, 0.80 to 0.88; P < .001). At week 24, there was no significant between-group difference in median change from baseline in the 6-minute walk distance with an increase of 9.7 m vs 12.2 m (adjusted mean difference, -2.5 m; 95% CI, -8.5 to 3.5; P = .42). There was no significant between-group difference in the mean change in the Kansas City Cardiomyopathy Questionnaire clinical summary score (12.3 vs 11.8; mean difference, 0.52; 95% CI, -0.93 to 1.97) or improvement in NYHA class (23.6% vs 24.0% of patients; adjusted odds ratio, 0.98; 95% CI, 0.81 to 1.18). The most frequent adverse events in the sacubitril/valsartan group vs the comparator group were hypotension (14.1% vs 5.5%), albuminuria (12.3% vs 7.6%), and hyperkalemia (11.6% vs 10.9%). Conclusions and Relevance Among patients with heart failure and left ventricular ejection factor of higher than 40%, sacubitril/valsartan treatment compared with standard renin angiotensin system inhibitor treatment or placebo resulted in a significantly greater decrease in plasma N-terminal pro-brain natriuretic peptide levels at 12 weeks but did not significantly improve 6-minute walk distance at 24 weeks. Further research is warranted to evaluate potential clinical benefits of sacubitril/valsartan in these patients. Trial Registration ClinicalTrials.gov Identifier: NCT03066804.

Mycologia, 2020

ABSTRACT Chlorophyllum accommodates lamellate agaricoid species as well as sequestrate angiocarpi... more ABSTRACT Chlorophyllum accommodates lamellate agaricoid species as well as sequestrate angiocarpic taxa, which do not form a monophyletic lineage within the genus. To clarify phylogenetic affinities and delimit species boundaries among sequestrate representatives of the genus, we analyzed historical and contemporary material from a broad geographic range, encompassing North America, southern Africa, eastern Asia, the Greek and Iberian peninsulas, and the Mediterranean islands of Cyprus and Lesvos. Six sequestrate lineages of Chlorophyllum were identified, which appear to have evolved in at least three independent gasteromycetation events. Multigene analysis of the nuc rDNA internal transcribed spacer region ITS1-5.8S-ITS2 (ITS) and portions of the nuc 28S rDNA (28S), RNA polymerase II second largest subunit (rpb2), and translation elongation factor 1-α (tef1) genes revealed the presence of a previously undescribed species, introduced here as Chlorophyllum levantinum, sp. nov. Its sister species C. lusitanicum, previously known only from Spain, is shown to have a wider distribution throughout the Mediterranean basin. A South African collection of Secotium gueinzii, a poorly known taxon described in 1840 and seldom appearing in literature since, was also shown to nest within Chlorophyllum. An epitype for this rare species is designated, Secotium becomes a priority synonym of Chlorophyllum, and nomenclatural implications are discussed. The phylogenetic placement of C. arizonicum is confirmed after successful sequencing of the century-old holotype and an undescribed sister lineage of this species detected. Emended descriptions of sections Chlorophyllum, Endoptychorum, and Sphaerospororum are provided to reflect current results, along with updated descriptions and extensive imagery for all known sequestrate taxa of Chlorophyllum.

European Journal of Heart Failure, 2021

The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness... more The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations.

Mycologia, 2021

ABSTRACT Over 80 species are recognized in the commercially important genus Morchella, many of th... more ABSTRACT Over 80 species are recognized in the commercially important genus Morchella, many of them endemic to specific regions or continents. Among them, M. anatolica and M. rufobrunnea are the earliest diverging lineages and are key in decoding the evolutionary history, global biogeography, and ecological trends within this iconic genus. Early ancestral area reconstruction (AAR) tests postulated a western North American origin of morels but had not included in the analyses M. anatolica, whose phylogenetic identity remained at the time unresolved. Following new collections of M. anatolica and M. rufobrunnea from the Mediterranean islands of Cyprus, Kefalonia, Lesvos, Malta, and Zakynthos, we performed revised AAR tests to update the historical biogeography of the genus. Our results, inferred from multilocus analysis of an expanded data set of 79 phylospecies, challenge previous reconstructions and designate the Mediterranean basin as the most likely place of origin for morels. Detailed morphoanatomical analyses demonstrate that ascocarp rufescence, the nondarkening apothecial ridges, the absence of a sinus, and the stipe pruinescence are all stable synapomorphic features of sect. Rufobrunnea, which could be interpreted as ancestral for the genus. The saprotrophic mode of nutrition, suggested by the prolific in vitro growth of M. anatolica, might also be an ancestral trait. Emended descriptions, including extensive imagery and scanning electron microscopy, are provided, and a new evolutionary hypothesis of the genus is proposed.

Fungal Ecology, 2019

Abstract Fungi historically placed in the iconic genera of Boletus, Leccinum and Xerocomus have b... more Abstract Fungi historically placed in the iconic genera of Boletus, Leccinum and Xerocomus have been the subject of major taxonomic revisions in recent years. Yet, despite all advancements in systematics, boletoid fungi in insular ecosystems remain little explored and our knowledge of their diversity, distribution and abundance in Mediterranean ecoregions is far from complete. To shed light on this blind spot, the findings of a ten-year study from the island of Cyprus were analysed, integrating phylogenetic, ecological, morphological, phenological and chorological data. An unexpected diversity of Boletaceae fungi is unveiled, with twenty-five species phylogenetically confirmed to be present on the island, thirteen of them previously unreported. Sequencing of the ITS rDNA region, reveals crypticism within the Butyriboletus fechtneri, Caloboletus radicans, Rubroboletus lupinus and Rheubarbariboletus armeniacus species-complexes and infrageneric relationships are discussed. A strong link between boletoid fungi and Mediterranean oaks of the ilicoid group (Quercus alnifolia, Quercus coccifera subsp. calliprinos) is illustrated, with nineteen species (76%) overall found to be strictly or broadly associated with evergreen oaks. In stark contrast, the semi-deciduous Quercus infectoria subsp. veneris appears to be an unfavorable host for boletoid fungi, with just a single associated species so far. Phenological and chorological records indicate that most species on the island are rare, highly localized and fruit during very brief spells several years apart, mainly in response to increased annual, late summer or early autumn precipitation. The conservation status of these high-profile fungi is hence discussed, particularly in view of alarming climate changes, forecasted to have a dramatic impact on Mediterranean ecosystems in the years to come.

IMA fungus, 2018

Nomenclatural type definitions are one of the most important concepts in biological nomenclature.... more Nomenclatural type definitions are one of the most important concepts in biological nomenclature. Being physical objects that can be re-studied by other researchers, types permanently link taxonomy (an artificial agreement to classify biological diversity) with nomenclature (an artificial agreement to name biological diversity). Two proposals to amend the International Code of Nomenclature for algae, fungi, and plants (ICN), allowing DNA sequences alone (of any region and extent) to serve as types of taxon names for voucherless fungi (mainly putative taxa from environmental DNA sequences), have been submitted to be voted on at the 11 International Mycological Congress (Puerto Rico, July 2018). We consider various genetic processes affecting the distribution of alleles among taxa and find that alleles may not consistently and uniquely represent the species within which they are contained. Should the proposals be accepted, the meaning of nomenclatural types would change in a fundament...

Heart and Metabolism, 2010

Myocardial energy metabolism may be normal in the early stages of heart failure but, as failure p... more Myocardial energy metabolism may be normal in the early stages of heart failure but, as failure progresses, mitochondrial oxidative metabolism is reduced and glycolysis is increased, with downregulation of glucose oxidation. Reducing free fatty acid oxidation and a concomitant increase in glucose oxidation improve cardiac contraction and slow the progression of left ventricular failure. Trimetazidine (TMZ) acts as a partial inhibitor of fatty acid oxidation and in turn stimulates glucose oxidation. In several studies, treatment with TMZ was found to result in a significant improvement in functional ability, left ventricular function, and the remodeling process in non diabetic, diabetic, ischemic, and non ischemic left ventricular dysfunction. Therefore, there is a compelling argument to advocate the use of TMZ in addition to conventional evidence-based treatments in the management of heart failure. Heart Metab. 2010;47:23‐26.

Studies in health technology and informatics

Journal of Physics: Conference Series, 2013

Simulation studies of statistical distributions of cell membrane capacities and an ellipse model ... more Simulation studies of statistical distributions of cell membrane capacities and an ellipse model to assess the frequency behaviour of biological tissues Willard Gerritsen, Robin van den Berg, Jan Mulder et al.

BMC Cardiovascular Disorders, 2011

Background: More than one third of adult population in Estonia has problems with elevated blood p... more Background: More than one third of adult population in Estonia has problems with elevated blood pressure (BP). The Hypertension in Estonia (HYPEST) study represents the country's first hypertension-targeted sample collection aiming to examine the epidemiological and genetic determinants for hypertension (HTN) and related cardiovascular diseases (CVD) in Estonian population. The HYPEST subjects (n = 1,966) were recruited across Estonia between 2004-2007 including clinically diagnosed HTN cases and population-based controls. The present report is focused on the clinical and epidemiological profile of HYPEST cases, and gender-specific effects on the pathophysiology of hypertension. Methods: Current analysis was performed on 1,007 clinically diagnosed HTN patients (617 women and 390 men) aged 18-85 years. The hypertensives were recruited to the study by BP specialists at the North Estonia Medical Center, Centre of Cardiology, Tallinn or at the Cardiology Clinic, Tartu University Hospital, Estonia. Longitudinal BP data was extracted retrospectively from clinical records. Current and retrospective data of patient's medical history, medication intake and lifestyle habits were derived from self-administrated questionnaire and each variable was examined separately for men and women. Eleven biochemical parameters were measured from fasting serum samples of 756 patients. Results: The distribution of recruited men and women was 39% and 61% respectively. Majority of Estonian HTN patients (85%) were overweight (BMI ≥ 25 kg/m 2) and a total of 79% of patients had additional complications with cardiovascular system. In men, the hypertension started almost 5 years earlier than in women (40.5 ± 14.5 vs 46.1 ± 12.7 years), which led to earlier age of first myocardial infarction (MI) and overall higher incidence rate of MI among male patients (men 21.2%, women 8.9%, P < 0.0001). Heart arrhythmia, thyroid diseases, renal tubulointestinal diseases and hyperlipidemia were more prevalent in hypertensive women compared to men (P < 0.0001). An earlier age of HTN onset was significantly associated with smoking (P = 0.00007), obesity (BMI ≥ 30 kg/m 2 ; P = 0.0003), increased stress (P = 0.0003) and alcohol consumption (P = 0.004). Conclusion: Understanding the clinical profile of HTN patients contributes to CVD management. Estonian hypertension patients exhibited different disease and risk profiles of male and female patients. This wellcharacterized sample set provides a good resource for studying hypertension and other cardiovascular phenotypes.

European Journal of Heart Failure

Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issu... more Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence‐based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF.