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Article: Comparative evaluation of microprobe versus conventional transoesophageal echocardiography for PFO closure guidance.

Lanki, Jemina / Tuohinen, Suvi / Simonen, Piia / Jalanko, Mikko / Sinisalo, Juha

2024 Volume 11, Issue 1

Abstract: Background: Patent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE- ... ...

Abstract	Background: Patent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE-probe (microTNE) is tolerated under conscious sedation and offers an effective alternative to TEE. The aim of this study was to compare the feasibility, safety and time expenditure of PFO closure using conventional TEE versus microTNE guidance. Methods: Consecutive patients assigned for PFO losure in Helsinki University Hospital from 2003 to 2021 were included in the study (n=336). TEE with general anaesthesia was used until November 2018 (n=167) while microTNE-guided PFO closure (n=169) under conscious sedation was the principal method thereafter. Patients were followed for 3 months after PFO closure. Results: The microTNE-route success rate was 97.2% vs TEE 100% (p=0.06) and procedure success rate was 97.7% with microTNE and 96.0% with TEE-guidance (p=0.54). The procedure time was significantly shorter with microTNE 21±7 min than with TEE 30±13 min (p<0.001). At the beginning of microTNE era, nasal bleeding complication was quite frequent; however, overall complication rates were equal between the groups. However, C reactive protein (CRP) increase was significantly milder with microTNE than TEE 1.0±2.9 vs 3.0±4.0 mg/L (p<0.001). An increase in CRP was independently associated with procedure type (p=0.004) and time (p=0.003). Conclusions: MicroTNE is a feasible and safe alternative for PFO closure guidance. MicroTNE under conscious sedation shortens procedure duration and induces a milder inflammatory reaction than conventional TEE under general anaesthesia.
MeSH term(s)	Humans ; Echocardiography, Transesophageal ; Echocardiography ; C-Reactive Protein ; Hospitals, University
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2024-01-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2023-002502
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Article: Formulation in clinical interviews.

Simonen, Mika

Communication & medicine

2014 Volume 9, Issue 2, Page(s) 133–143

Abstract: Formulation, according to Garfinkel and Sacks (1986 [1969]), refers to speakers' ways of talking about the current interaction. This article explores how formulations are used in clinical assessment interviews as a way of providing evidence of the ... ...

Abstract	Formulation, according to Garfinkel and Sacks (1986 [1969]), refers to speakers' ways of talking about the current interaction. This article explores how formulations are used in clinical assessment interviews as a way of providing evidence of the respondent's capacities that are currently assessed. The videotaped data are drawn from the clinical interviews of unemployed adults and older persons. The data are analyzed using conversation analysis (CA). The article shows how formulation is achieved through vocalized and/or embodied actions (e.g., nodding index finger pointing), in conjunction with the speaker's gaze directed to the recipient. It argues that these formulations enable access to the shared epistemic domain of the current interaction. This domain is an interactional achievement and, as a resource, it allows the participants to designate viewpoints regarding the respondent's social competence. In sum, the paper demonstrates how participants can show an explicit orientation to the interactional substrate of interview.
MeSH term(s)	Communication ; Humans ; Interpersonal Relations ; Interviews as Topic/methods ; Videotape Recording
Language	English
Publishing date	2014-02-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2141404-X
ISSN	1612-1783
ISSN	1612-1783
DOI	10.1558/cam.v9i2.133
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Article ; Online: The effect of hydroxychloroquine on cholesterol synthesis depends on the profile of cholesterol metabolism. A controlled clinical study.

Simonen, Piia / Ulander, Lotta / Eklund, Kari K / Niemi, Mikko / Backman, Janne T / Gylling, Helena / Sinisalo, Juha

Atherosclerosis plus

2024 Volume 55, Page(s) 93–97

Abstract: Background and aims: Hydroxychloroquine (HCQ) has a variable effect on cholesterol synthesis. To clarify this, we assessed the effect of HCQ on the cholesterol-synthesis pathway in individuals with low and high cholesterol absorption efficiency.: ... ...

Abstract	Background and aims: Hydroxychloroquine (HCQ) has a variable effect on cholesterol synthesis. To clarify this, we assessed the effect of HCQ on the cholesterol-synthesis pathway in individuals with low and high cholesterol absorption efficiency. Method: A total of 53 acute myocardial infarction patients with a constant statin dose randomized to receive HCQ or placebo for six months in a double-blind manner, were classified further into low (n = 26) and high (n = 27) cholesterol absorbers based on the median baseline serum cholestanol level. Serum lipids and biomarkers of cholesterol synthesis (squalene, lanosterol, zymostenol, desmosterol, and lathosterol) and absorption efficiency (sitosterol and cholestanol), were measured at baseline and one-, six-, and 12-month follow-up visits. Results: In low cholesterol absorbers, serum cholesterol concentration and cholesterol synthesis and absorption biomarkers did not differ between the HCQ and placebo groups. At one month, high cholesterol absorbers with HCQ had lower serum cholesterol concentration and serum lanosterol to cholesterol ratio in comparison to the placebo group (HCQ 3.18 ± 0.62 vs. placebo 3.71 ± 0.65, p = 0.042, and HCQ 10.4 ± 2.55 vs. placebo 13.1 ± 2.36, p = 0.008, respectively). At 12 months, serum desmosterol to cholesterol ratio was lower in HCQ users (HCQ 47.1 ± 7.08 vs. placebo 59.0 ± 13.1, p = 0.011). Conclusions: HCQ affects the cholesterol-synthesis pathway in high cholesterol absorbers. It reduces serum lanosterol and desmosterol ratios and consequently serum cholesterol concentration possibly by inhibiting the activity of lanosterol synthase as described earlier in Trial registration: ClinicalTrials.gov Identifier: NCT02648464.
Language	English
Publishing date	2024-03-01
Publishing country	Netherlands
Document type	Journal Article
ISSN	2667-0895
ISSN (online)	2667-0895
DOI	10.1016/j.athplu.2024.02.002
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Article ; Online: Obesity Does Not Interfere with the Cholesterol-Lowering Effect of Plant Stanol Ester Consumption (as Part of a Heart-Healthy Diet).

Simonen, Piia / Arte, Elisa / Gylling, Helena

Journal of cardiovascular development and disease

2021 Volume 8, Issue 4

Abstract: ... as normal-weight (BMI ≤ 25 kg/m ...

Abstract	Dietary modifications including plant stanol ester consumption are recommended measures to control serum and low-density lipoprotein (LDL)-cholesterol concentrations, but obesity can affect their responses. We investigated whether body mass index (BMI) affects serum cholesterol levels during plant stanol (mainly sitostanol) ester consumption. This ad hoc analysis was based on earlier results of a cross-over, randomized controlled trial of postmenopausal women consuming rapeseed oil-based margarine without or with plant stanol ester (3 g plant stanols/day) for seven weeks. We classified the subjects as normal-weight (BMI ≤ 25 kg/m
Language	English
Publishing date	2021-04-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd8040036
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Article ; Online: Smartphone-Based Recognition of Heart Failure by Means of Microelectromechanical Sensors.

Haddad, Francois / Saraste, Antti / Santalahti, Kristiina M / Pänkäälä, Mikko / Kaisti, Matti / Kandolin, Riina / Simonen, Piia / Nammas, Wail / Jafarian Dehkordi, Kamal / Koivisto, Tero / Knuuti, Juhani / Mahaffey, Kenneth W / Blomster, Juuso I

JACC. Heart failure

2024

Abstract: Background: Heart failure (HF) is the leading cause of hospitalization in individuals over 65 years of age. Identifying noninvasive methods to detect HF may address the epidemic of HF. Seismocardiography which measures cardiac vibrations transmitted to ... ...

Abstract	Background: Heart failure (HF) is the leading cause of hospitalization in individuals over 65 years of age. Identifying noninvasive methods to detect HF may address the epidemic of HF. Seismocardiography which measures cardiac vibrations transmitted to the chest wall has recently emerged as a promising technology to detect HF. Objectives: In this multicenter study, the authors examined whether seismocardiography using commercially available smartphones can differentiate control subjects from patients with stage C HF. Methods: Both inpatients and outpatients with HF were enrolled from Finland and the United States. Inpatients with HF were assessed within 2 days of admission, and outpatients were assessed in the ambulatory setting. In a prespecified pooled data analysis, algorithms were derived using logistic regression and then validated using a bootstrap aggregation method. Results: A total of 217 participants with HF (174 inpatients and 172 outpatients) and 786 control subjects from cardiovascular clinics were enrolled. The mean age of participants with acute HF was 64 ± 13 years, 64.9% were male, left ventricular ejection fraction was 39 ± 15%, and median N-terminal pro-B-type natriuretic peptide was 5,778 ng/L (Q1-Q3: 1,933-6,703). The majority (74%) of participants with HF had reduced EF, and 38% had atrial fibrillation. Across both HF cohorts, the algorithms had an area under the receiver operating characteristic curve of 0.95 with a sensitivity of 85%, specificity of 90%, and accuracy of 89% for the detection of HF, with a decision threshold of 0.5. The positive and negative likelihood ratios were 8.50 and 0.17, respectively. The accuracy of the algorithms was not significantly different in subgroups based on age, sex, body mass index, and atrial fibrillation. Conclusions: Smartphone-based assessment of cardiac function using seismocardiography is feasible and differentiates patients with HF from control subjects with high diagnostic accuracy. (Recognition of Heart Failure With Micro Electro-mechanical Sensors FI [NCT04444583]; Recognition of Heart Failure With Micro Electro-mechanical Sensors [NCT04378179]; Detection of Coronary Artery Disease With Micro Electro-mechanical Sensors [NCT04290091]).
Language	English
Publishing date	2024-04-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2705621-1
ISSN	2213-1787 ; 2213-1779
ISSN (online)	2213-1787
ISSN	2213-1779
DOI	10.1016/j.jchf.2024.01.022
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Article ; Online: End-Stage Heart Failure in Cardiac Sarcoidosis.

Velikanova, Diana / Pöyhönen, Pauli / Lehtonen, Jukka / Simonen, Piia / Uusitalo, Valtteri / Vihinen, Tapani / Kaikkonen, Kari / Haataja, Petri / Kerola, Tuomas / Rissanen, Tuomas T / Vepsäläinen, Ville / Alatalo, Aleksi / Pietilä-Effati, Päivi / Kupari, Markku

Circulation

2024 Volume 149, Issue 11, Page(s) 885–887

MeSH term(s)	Humans ; Cardiomyopathies/diagnosis ; Cardiomyopathies/diagnostic imaging ; Heart Failure/diagnosis ; Heart Failure/etiology ; Sarcoidosis/complications ; Sarcoidosis/diagnosis ; Heart Transplantation
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.123.066962
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Book ; Thesis: TOIMINNANVAJAVUUS JA IKAEAENTYNEET PITKAAEAIKAISSAIRAAT

Simonen, Helena

= DISABILITY AND THE AGED WITH CHRONIC ILLNESS

(KANSANTERVEYSTIETEEN JULKAISUJA : M ; 53)

1980

Title variant	TOIMINNANVAJAVUUS JA IKAEAENTYNEET PITKAEAIKAISSAIRAAT ; DISABILITY AND THE AGED WITH CHRONIC ILLNESS
Series title	KANSANTERVEYSTIETEEN JULKAISUJA : M ; 53 Kansanterveystieteen julkaisuja KANSANTERVEYSTIETEEN JULKAISUJA ; M
Collection	Kansanterveystieteen julkaisuja KANSANTERVEYSTIETEEN JULKAISUJA ; M
Size	165 S.
Document type	Book ; Thesis
Thesis / German Habilitation thesis	HELSINKI, UNIV., DISS., 1980
HBZ-ID	HT002265666
ISBN	951-45-1904-3 ; 978-951-45-1904-8
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Noncholesterol Sterols as Surrogate Markers in Patients with Severe Alcoholic Hepatitis.

Sahlman, Perttu / Nissinen, Markku / Simonen, Piia / Färkkilä, Martti

Lipids

2018 Volume 53, Issue 3, Page(s) 323–334

Abstract: Severe alcoholic hepatitis (AH) is a life-threatening condition lacking good serologic markers to tailor treatment and predict recovery. We examined the cholesterol metabolism in severe AH to explore prognostic markers and evaluate the profile of ... ...

Abstract	Severe alcoholic hepatitis (AH) is a life-threatening condition lacking good serologic markers to tailor treatment and predict recovery. We examined the cholesterol metabolism in severe AH to explore prognostic markers and evaluate the profile of cholesterol precursors, cholestanol and phytosterols, in this context. We assessed serum cholesterol, cholesterol precursors, cholestanol, phytosterols, and biochemical markers in 24 patients with severe AH treated with prednisolone and randomized to ciprofloxacin in the ratio 1:1. Response to prednisolone was assessed with the Lille model. Evaluations were made between responders and nonresponders to corticosteroid treatment and during follow-up for 180 days. The findings were compared with those from patients with primary sclerosing cholangitis (PSC) (n = 156) and healthy individuals (n = 124). Responders to prednisolone had ~56-60% higher (p-value 0.032-0.044) serum ratios to cholesterol of phytosterols, while the lathosterol/campesterol ratio was ~76% (p = 0.031) lower compared to nonresponders. Stigmasterol/cholesterol predicted response to corticosteroid therapy. Surrogate markers of cholesterol synthesis (lathosterol and desmosterol) inversely reflected those of absorption (cholestanol and phytosterols) in PSC and controls (r-range -0.247 to -0.559, p < 0.01 for all), contrary to AH patients, among whom this reciprocal regulation was partially recovered on day 90 (lathosterol: r-range -0.733 to -0.952, p < 0.05 for all). AH patients had ~26% lower lathosterol/cholesterol, but 1.13-3.87-fold higher cholestanol/cholesterol and sitosterol/cholesterol compared to control groups (p < 0.05 for all). Median ferritin concentration at baseline was ~37% lower (p = 0.011) among the responders. Cholesterol precursors and phytosterols have a disease-specific profile in AH. Phytosterols and ferritin may serve as surrogate markers for short-term response.
MeSH term(s)	Adult ; Aged ; Anti-Inflammatory Agents/therapeutic use ; Biomarkers/blood ; Cholangitis, Sclerosing/blood ; Cholangitis, Sclerosing/diagnosis ; Cholangitis, Sclerosing/drug therapy ; Cholangitis, Sclerosing/pathology ; Cholestanol/blood ; Cholesterol/blood ; Ciprofloxacin/therapeutic use ; Female ; Ferritins/blood ; Follow-Up Studies ; Hepatitis, Alcoholic/blood ; Hepatitis, Alcoholic/diagnosis ; Hepatitis, Alcoholic/drug therapy ; Hepatitis, Alcoholic/pathology ; Humans ; Male ; Middle Aged ; Phytosterols/blood ; Prednisolone/therapeutic use ; Severity of Illness Index
Chemical Substances	Anti-Inflammatory Agents ; Biomarkers ; Phytosterols ; Ciprofloxacin (5E8K9I0O4U) ; Cholestanol (8M308U816E) ; Ferritins (9007-73-2) ; Cholesterol (97C5T2UQ7J) ; Prednisolone (9PHQ9Y1OLM)
Language	English
Publishing date	2018-04-16
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Randomized Controlled Trial
ZDB-ID	241539-2
ISSN	1558-9307 ; 0024-4201
ISSN (online)	1558-9307
ISSN	0024-4201
DOI	10.1002/lipd.12033
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Article ; Online: Long-Term Outcome in Probable Versus Absolute Cardiac Sarcoidosis.

Simonen, Piia / Lehtonen, Jukka / Kupari, Markku

The American journal of cardiology

2018 Volume 123, Issue 4, Page(s) 674–678

Abstract: Suspicion of cardiac sarcoidosis (CS) arises when a patient has clinical cardiac manifestations and findings on cardiac imaging suggestive of inflammatory cardiomyopathy with or without history of extracardiac sarcoidosis. The additional requirement for ... ...

Abstract	Suspicion of cardiac sarcoidosis (CS) arises when a patient has clinical cardiac manifestations and findings on cardiac imaging suggestive of inflammatory cardiomyopathy with or without history of extracardiac sarcoidosis. The additional requirement for diagnosis is proof of sarcoidosis histology. Endomyocardial biopsy (EMB) showing granulomatous inflammation in absence of other explanations confirms an absolute diagnosis of CS while similar histology in an extracardiac biopsy gives a probable diagnosis of CS. Our aim was to study the equivalence of probable to absolute CS in terms of patients' characteristics and outcome. We reviewed the available clinical information, diagnostic procedures, details of treatment and event-free survival of 149 consecutive patients (103 women, mean age 50 y) diagnosed with CS at our institution. The diagnosis was absolute in 68 patients and probable in 81 patients. There was no difference in age or sex distribution between the diagnostic subgroups but left ventricular dysfunction on echocardiography (ejection fraction <50%) was more common in absolute CS (60% vs 36%, p = 0.003) as was abnormal myocardial late gadolinium enhancement on magnetic resonance imaging (96% vs 78%, p = 0.006). Over a median of 54 months of follow-up, 19 of 68 patients with absolute CS versus 15 of 81 with probable CS either died, suffered an aborted sudden cardiac death or underwent cardiac transplantation (log rank p = 0.334). In conclusion, in terms of prognosis, clinical diagnosis of CS supported by extracardiac histology is equivalent to diagnosis confirmed by myocardial histology. No distinction should be made between probable and absolute CS as regards treatment and follow-up.
MeSH term(s)	Adult ; Cardiomyopathies/diagnosis ; Cardiomyopathies/mortality ; Cardiomyopathies/therapy ; Echocardiography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Progression-Free Survival ; Retrospective Studies ; Sarcoidosis/diagnosis ; Sarcoidosis/mortality ; Sarcoidosis/therapy ; Stroke Volume ; Survival Rate
Language	English
Publishing date	2018-11-24
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2018.11.007
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Article ; Online: The effect of hydroxychloroquine on cholesterol metabolism in statin treated patients after myocardial infarction.

Ulander, Lotta / Simonen, Piia / Tolppanen, Heli / Hartman, Otto / Rissanen, Tuomas T / Eklund, Kari K / Kalaoja, Marita / Kurkela, Mika / Neuvonen, Mikko / Niemi, Mikko / Backman, Janne T / Gylling, Helena / Sinisalo, Juha

Atherosclerosis plus

2023 Volume 53, Page(s) 26–32

Abstract: Background and aims: To evaluate the effect of hydroxychloroquine (HCQ) on serum and lipoprotein lipids and serum biomarkers of cholesterol synthesis and absorption in myocardial infarction patients with a high-dose statin.: Methods: Myocardial ... ...

Abstract	Background and aims: To evaluate the effect of hydroxychloroquine (HCQ) on serum and lipoprotein lipids and serum biomarkers of cholesterol synthesis and absorption in myocardial infarction patients with a high-dose statin. Methods: Myocardial infarction patients (n = 59) with a constant statin dose were randomized to receive hydroxychloroquine 300 mg (n = 31) or placebo (n = 28) daily for six months and followed up for one year. Results: Statin reduced total-c (-26 ± 22% in hydroxychloroquine and -28 ± 19% in placebo group, P = 0.931), LDL-c (-38 ± 26% vs. -44 ± 23%, respectively, P = 0.299), and cholesterol synthesis biomarkers zymostenol, desmosterol, and lathosterol ratios from baseline to one year (e.g., serum lathosterol ratio -17 ± 45% vs. -15 ± 41%, respectively, P < 0.001 for both, P = 0.623 between groups). Compensatorily, cholesterol absorption increased during the intervention (e.g., serum campesterol ratio 125 ± 90% vs. 113 ± 72%, respectively, P < 0.001 for both, P = 0.488 between groups). Hydroxychloroquine did not affect cholesterol concentrations or cholesterol absorption. It prevented the statin-induced increase in cholesterol precursor, desmosterol ratio, from six months to one year in the hydroxychloroquine group (P = 0.007 at one year compared to placebo). Conclusions: Combined with a high-dose statin, hydroxychloroquine had no additional effect on serum cholesterol concentration or cholesterol absorption. However, the findings suggest that hydroxychloroquine interferes with lanosterol synthesis, and thereafter, it temporarily interferes with the cholesterol synthesis pathway, best seen in halting the increase of the desmosterol ratio.Trial Registration ClinicalTrials.gov Identifier: NCT02648464.
Language	English
Publishing date	2023-06-26
Publishing country	Netherlands
Document type	Journal Article
ISSN	2667-0895
ISSN (online)	2667-0895
DOI	10.1016/j.athplu.2023.06.003
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