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Abstract Background Oral microbiome has significant impact on both oral and general health. Polyols have been promoted as sugar substitutes in prevention of oral diseases. We aimed to reveal the effect of candies containing erythritol, xylitol or control (sorbitol) on salivary microbiome. Methods Ninety children (11.3 ± 0.6 years) consumed candies during 3 years. Microbial communities were profiled using Illumina HiSeq 2000 sequencing and real-time PCR. Results The dominant phyla in saliva were Firmicutes (39.1%), Proteobacteria (26.1%), Bacteroidetes (14.7%), Actinobacteria (12%) and Fusobacteria (6%). The microbiome of erythritol group significantly differed from that of the other groups. Both erythritol and xylitol reduced the number of observed bacterial phylotypes in comparison to the control group. The relative abundance of the genera Veillonella, Streptococcus and Fusobacterium were higher while that of Bergeyella lower after erythritol intervention when comparing with control. The lowest prevalence of caries-related mutans streptococci corresponded with the lowest clinical caries markers in the erythritol group. Conclusions Daily consumption of erythritol, xylitol or control candies has a specific influence on the salivary microbiome composition in schoolchildren. Erythritol is associated with the lowest prevalence of caries-related mutans streptococci and the lowest levels of clinical caries experience. Trial registration ClinicalTrials.gov Identifier NCT01062633.

Background: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy.Methods: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications.Results: A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed < or =30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies.Conclusions: This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the advantages and disadvantages of laparoscopic hysterectomy over a 2-year period when this new technique was introduced to several hospitals in Finland.Study Design: A nationwide register was founded and a prospective multicenter survey of 1165 laparoscopic hysterectomies was carried out from January 1993 to December 1994. The operations were performed because of uterine fibroids (54%), menorrhagia (27%), dysmenorrhea (8%), endometriosis (2%), and other reasons (9%) by 68 gynecologists at 30 hospitals.Results: The mean operation time was 132 minutes. The patients stayed in hospital for an average of 3.3 days, and the mean convalescence period was 17.9 days, half that after abdominal hysterectomy. Complications occurred in 10.2% of the procedures: infections in 5.6%, vascular complications in 1.2%, urinary tract complications in 2.7%, and bowel complications in 0.4%.Conclusions: Laparoscopic hysterectomy offers a short hospital stay and convalescence time to the patient, but effective teaching is imperative to minimize, in particular, the risk of urinary tract injuries. [ABSTRACT FROM AUTHOR]

Objective. To provide a comprehensive overview of published evidence on the impact of erythritol, a noncaloric polyol bulk sweetener, on oral health. Methods. A literature review was conducted regarding the potential effects of erythritol on dental plaque (biofilm), dental caries, and periodontal therapy. The efficacy of erythritol on oral health was compared with xylitol and sorbitol. Results. Erythritol effectively decreased weight of dental plaque and adherence of common streptococcal oral bacteria to tooth surfaces, inhibited growth and activity of associated bacteria like S. mutans, decreased expression of bacterial genes involved in sucrose metabolism, reduced the overall number of dental caries, and served as a suitable matrix for subgingival air-polishing to replace traditional root scaling. Conclusions. Important differences were reported in the effect of individual polyols on oral health. The current review provides evidence demonstrating better efficacy of erythritol compared to sorbitol and xylitol to maintain and improve oral health.

The aim of this article is to answer the question, “What are the prerequisites for the success of Finland’s regions and smaller areas, when barriers to trade are being lowered and Finland is integrated into the international economy?” The answer is based on a study where regional success factors are defined primarily on the basis of Porter’s concept of “the competitive advantage of nations.” Empirical findings and observations on the most important locational factors of industrial firms in the modern regional economy add to this definition. The success factors are grouped into two blocks: (1) economic activities (five variables), and (2) locational factors of industrial firms (eight variables). Both blocks of variables are analysed with the help of principal components analysis. On the basis of the regional values produced by the first principal component of both blocks, the regions and small economic areas are grouped into four categories that represent their respective competitive advantage. This is done by means of cluster analysis. Uusimaa, the southernmost region of Finland that includes the capital city Helsinki, is in the best position and has the best prerequisites for success. The next regions are Southwest Finland with its main centre Turku and the Tampere region (Pirkanmaa). South Ostrobothnia, North Karelia, South Savo, and Central Ostrobothnia have the weakest prerequisites of all nineteen regions. The disparities within the regions are often considerable. The core area of the region is generally in the best position. After the Helsinki area, the small economic areas of Turku, Tampere, Oulu, and Jyväskylä are in a good position, followed by Vaasa, Kuopio, Lahti, and Pori. Related studies carried out in the latter part of the 1990s confirm these results almost without exception. The results suggest that the polarisation of Finland’s regional economy continues. The new national regional development program, approved by the Finnish government for the period 2001–2006, supports this view of the future.

The ambitious aim of this study was to find an answer to the question what are the prerequisites for success of Finland's sub-areas when barriers to trade are lowering and Finland is being integrated with the international economy. The first step of the study was to define the regional success factors, the strengths and weaknesses, with respect to internationalisation. The factors were defined e.g. on the basis of Porter's concept of the competitive advantage of nations as well as the empirical findings and ideas on the most important locational factors of industrial firms. The data were gathered from the statistics and registers of Statistics Finland. The success factors were grouped into two main blocks: 1) economic activities (five variables), and 2) locational factors of industrial firms (nine variables). Both blocks of variables were then analysed with the help of principal components analysis, and finally, on the basis of the regional points produced by the first principal component of both blocks, the regions were grouped into four categories representing their competitive advantage. Uusimaa, the southernmost region of Finland with the capital Helsinki, is in the best position and has the best prerequisites for success. The next regions are Southwest Finland with its main centre Turku, and the Tampere region. The regions of Central Ostrobothnia and South Ostrobothnia have the weakest prerequisites of all nineteen regions. The disparities within the regions are often great. The best situation generally occurs at the core area of the region. The weakest small economic areas are characterised by peripheral location, agricultural-related industries, rather low GNP per capita, low educational level of the population, and old age structure. On the basis of the results, polarisation of regional development is continuing at the same time as Finland is being internationalised.

The aim of the study was to establish which models of innovation diffusion and which special features characterize and explain the diffusion of the Rotary movement on global level and, in detail, in Finland. Cartographic techniques were employed as the main method of analysis, supported by cross‑tabulations and some statistical tests in the detailed study. The United States has played a central role in the global diffusion of the movement. Economic ties and common language have reduced the isolating impact of oceans. The movement has spread almost all over the world, the latest areas of diffusion being Central African states and Pacific Islands. Roughly speaking, the diffusion has advanced in order of economic devel­opment of countries. In the Old World, the communist ideology constitutes an absolute barrier to the diffusion of the movement. In Finland the Rotary movement has spread from south to north and from the coast to the interior and, at the same time, to the periphery. The diffusion has advanced fairly exactly in the hierarchical order determined by the administrative status of communes. On the lowest or rural commune level the significance of distance as an explanatory factor increases markedly. The diffusion process could be reduced to a cartographic synthesis com­bining the hierarchical and expansion diffusion types.

The study was performed through producing or utilizing available­ predictions of part‑factors in regional structure (distribution of population, systems of centres and spheres of influence, communication system, and vertical dimensions of spheres of influence of centres), and by uniting these into a total picture. The main task was a construction of a future system of centres and spheres of influence, on the basis of an analysis of the functional system at the beginning of the 1960's and the 1970's. Correlation and regression technique in addition to potential technique were applied as methods of examination. Population in the sphere of influence, in which the location of population was taken into consideration by means of weighting coefficients representing the frequency of visits to the centres, alone explained 98 per cent of the variation in the number of functional points, and the transformed population factor explained over 91 per cent of the variation in the number of functions. Classification of cen­tres on the basis of the centralities obtained by the regression and poten­tial models yielded a result which corresponded well with the empir­ically‑determined qualitative central classes. Prediction of centralities was carried out by multiple regression models as well as by the potential model. The centres were classified on the basis of the centralities obtained. The final central classification was the result of summarizing three classification results. A comparison with the classifications at earlier points of time indicated that on the higher hierarchical levels changes are slight, and on the lower levels the system of centres is becoming more wide‑meshed. Spheres of influence were delimited using formulas derived from Newton's law of gravitation. In the shape and size of the spheres of influence, common features with the regional system presented by Isard could be observed, but deviations also appeared. The predicted system of centres and spheres of influence could best be described by the expression 'mixed hierarchies'. As part‑factors in the communication system, private car and van traffic, railway and air traffic and tele‑communications were analysed from the point of view of the future. Of these, the private car and van traffic was selected to represent the communication system in the synthesis. In the cartographic synthesis the predicted part‑factors of the regional structure were combined on the same map using different colours. In the chorological synthesis, the elements were transformed to points in the chorological matrix, and the points were summed up by squares. The classification of points produced regional types, which were called functional cores, zones of intensive interaction, functional intermediary zones and functional periphery.

The main attention in the present study was focussed on quantitative observations of the influence that centres have on their surroundings. The relative area of influence of Forssa, which is situated in south‑western Häme, was selected as the empirical experimental area of the gravitational models. Gravitation was measured by the frequency of visits made to the centres, and the distance variable in the gravitational models was road‑distance. The linear model of the Pareto‑type as well as the square model were employed as func­tions expressing field force. In central class III, the square model appeared to adjust itself better to empirical changes in field force than the linear model, while in the lower class of centrality, class II, the models were approximately equal. As a whole, the differences in the explanatory degree of the models were so slight that the linear model could be interpreted as a reliable and, due to its simplicity, a very useful function to express field force. The decline in gravitation was studied in detail with the help of 4 profiles of field force as well as linear graphs calculated by sectors. The areal distribution of field force was illustrated by isarithmic maps. For their preparation the values of field force were computed by areal units with the aid of the filtering method, which was further improved by weighing coefficients. The general applicability of the method has already been verified in the treatment of data of visiting frequencies covering the whole country.

Background: In Finland, the number of hysterectomies during one decade has decreased by 34%. The national prospective FINHYST study in 1996 showed abdominal hysterectomy (AH) as being most common: 58%. In Finland since 2002, vaginal hysterectomy (VH) has been most preferred, with laparoscopic hysterectomy (LH) surpassing AH in 2005., Methods: FINHYST 2006 is a national prospective hysterectomy study in which all hospitals collaborated from 1 January to 31 December 2006. Questionnaires, completed by gynaecologists, covered their experience, patient characteristics and surgical data., Results: The 5279 hysterectomies distributed by approaches were 44% VHs, 32% LHs and 24% AHs. Less than 2% were subtotal. The main indications for hysterectomy were myomas (33%), uterine prolapse (28%) and menorrhagia (21%). The main indication for VH was not related to uterine prolapse in 39%. Bilateral salpingo-ooforectomy was performed in 36% of AHs, 32% of LHs and 2% of VHs. Antibiotic prophylaxis was used in 97%, and thrombosis prophylaxis in 65%. Haemorrhage was least and operation time shortest with VH, and hospital stay and sick leave were shortest after LH., Conclusions: In Finland, less invasive approaches comprise 76% of hysterectomies. This trend has resulted nationally in shortening of hospital stay and of convalescence time.

Background: The purpose of the study was to evaluate the immediate outcome and complications of the tension-free vaginal tape (TVT) and laparoscopic mesh colposuspension (LC) procedures in the treatment of female stress urinary incontinence (SUI)., Methods: One hundred and twenty-eight patients suffering from urodynamically confirmed SUI were recruited to this multicenter, randomized clinical trial. After randomization there were seven drop-outs--121 patients were operated upon: 70 patients in the TVT group and 51 in the LC group. The patients were evaluated according to the study protocol before operation and 6 weeks after it. The independent sample t-test and the Mann-Whitney U-test were used to calculate statistical differences between the study groups., Results: Immediate cure rates, defined as negative stress test with 300 mL saline in the bladder, were similar (92.9% in the TVT group and 88.2% in the LC group; p = ns). Return to normal voiding was faster in the TVT group (9.2 h in the TVT group vs. 24.4 h in the LC group; p = 0.004). Fewer analgesics were used in the TVT group and hospital stay was shorter in this group. Complication rates associated with the procedures were similar and the number of complications was small., Conclusions: The immediate outcome of both procedures is the same. The rates of complications were similar. However, the TVT procedure seems to be less invasive and requires fewer hospital resources than LC.

The ultrasonically activated scalpel has been shown to be a haemostatically effective cutting device in gynaecologic surgery. The introduction of laparosonic coagulating shears (Ethicon Endo-Surgery, Cincinnati, USA), with its multifunctionality, should have promoted wider use of the tool in major laparoscopic surgery, including hysterectomy and pelvic floor reconstructions. However, there is limited published data currently available on using ultrasonic energy in gynaecologic surgery.

This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, the patients received either tropisetron 5 mg, droperidol 1.25 mg, or 0.9% saline intravenously (i.v.). As a rescue antiemetic, the patients received metoclopramide 10 mg i.v.. The episodes of nausea, retching, and vomiting; the need for rescue treatment; and the type and severity of adverse events were recorded at four occasions during the 48-h observation period. Pain, anxiety, drowsiness, and general satisfaction were also evaluated on a linear numerical scale of 0-10. Complete response (no PONV within the 48-h observation period) occurred similarly in the study groups (tropisetron 25%, droperidol 22%, and placebo 18%). Tropisetron and droperidol had no effect on the incidence of nausea and retching. However, the incidence of vomiting was significantly less in the tropisetron group than in the placebo group (tropisetron 19%, droperidol 45%, and placebo 57%). The number of emetic episodes (retching and/or vomiting) per patient within 48 h was significantly decreased under tropisetron when compared with placebo (tropisetron 2.5 +/- 3.4, droperidol 4.2 +/- 6.1, placebo 5.9 +/- 7.1). With regard to adverse events, the patients in the droperidol group had significantly more anxiety than the placebo group (2-6 h postoperatively), more drowsiness than the tropisetron and placebo groups (0-2 h postoperatively), and more dissatisfaction than the tropisetron (0-6 h postoperatively) and placebo groups (2-6 h postoperatively). We conclude that tropisetron given 5 mg i.v. during anesthesia in gynecologic incontinence surgery effectively prevents vomiting but not nausea and retching, while 1.25 mg i.v. droperidol fails to prevent any of these emetic symptoms and results in adverse events.

Placenta accreta is a rare complication of pregnancy. Traditionally treatment has been operative, commonly total abdominal hysterectomy, in order to prevent serious haemorrhage or infection. Reproductive function can, however, be preserved by conservative management which is possible in carefully selected cases without risking maternal welfare. We report two cases of placenta accreta managed conservatively--both women delivered after this treatment.

We evaluated the ventilatory effects and blood gas changes of prolonged CO2-pneumoperitoneum in nor-moventilated patients and examined the respiratory and gas exchange consequences of head-down positioning (25-30 degrees) and CO2 insufflation into the peritoneal cavity in 20 patients without major cardiorespiratory disorders in various phases of laparoscopic hysterectomy. The patients received general anesthesia with isoflurane, fentanyl, and vecuronium, and minute ventilation (MV) was adjusted to maintain the PETCO2 at 33-36 mm Hg throughout the entire procedure, either by increasing the tidal volume (TV) and keeping the respiratory rate (RR) at 12/min (10 patients) or by changing the RR and maintaining the TV at 8 mL/kg (10 patients). Arterial and mixed venous blood samples were collected simultaneously for blood gas analysis and for measurements of oxygen consumption, and respiratory mechanics and gases were recorded by an anesthetic gas analyzer and side stream spirometry device. Oxygen consumption decreased with anesthesia, remained stable to the end of the laparoscopy, increased soon after deflation of the pneumoperitoneum, and reached preanesthetic values during recovery. The MV requirement increased by approximately 30% after the start of CO2 insufflation, then increased somewhat further toward the end of the laparoscopy, reaching the highest level a few minutes after deflation of the intraabdominal gas. The compliance decreased by 20% with the head-down position and by an additional 30% with the increased intraabdominal pressure. PaCO2 and mixed venous PCO2 increased with CO2 insufflation, and the arterial to end-tidal PCO2 (a-etPCO2) gradient increased by 1.5 mm Hg during laparoscopy. A mild metabolic acidosis developed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aim of the Study: To examine intracranial blood flow during major laparoscopic gynecologic operation and the effects of a deep Trendelenburg position and pneumoperitoneum on the flow., Material: Fifteen patients scheduled for laparoscopic hysterectomy., Methods: Trans-cranial Doppler examination of blood flow velocity waveforms in the middle cerebral artery during operation., Results: Trendelenburg position and pneumoperitoneum were followed by a decrease in cardiac output and an increase of central venous pressure and pulmonary capillary wedge pressure. No significant changes in the pulsatility index or maximal or mean blood flow velocities in the middle cerebral artery occurred during operations. A negative correlation between percentual changes in the pulsatility index and mean arterial pressure existed., Conclusions: Uncomplicated laparoscopic hysterectomy is not associated with harmful changes in intracranial circulation in spite of a Trendelenburg position, pneumoperitoneum and changes in the patient's extracranial hemodynamics.