Articles

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  • Prozorov, Sergei (Edinburgh University Press, 2016)
    Critical Connections
  • Hohtari, Helena; Bruck, Oscar; Blom, Sami; Turkki, Riku; Sinisalo, Marjatta; Kovanen, Panu E.; Kallioniemi, Olli; Pellinen, Teijo; Porkka, Kimmo; Mustjoki, Satu (2019)
    As novel immunological treatments are gaining a foothold in the treatment of acute lymphoblastic leukemia (ALL), it is elemental to examine ALL immunobiology in more detail. We used multiplexed immunohistochemistry (mIHC) to study the immune contexture in adult precursor B cell ALL bone marrow (BM). In addition, we developed a multivariate risk prediction model that stratified a poor survival group based on clinical parameters and mIHC data. We analyzed BM biopsy samples of ALL patients (n = 52) and healthy controls (n = 14) using mIHC with 30 different immunophenotype markers and computerized image analysis. In ALL BM, the proportions of M1-like macrophages, granzyme B+CD57+CD8+ T cells, and CD27+ T cells were decreased, whereas the proportions of myeloid-derived suppressor cells and M2-like macrophages were increased. Also, the expression of checkpoint molecules PD1 and CTLA4 was elevated. In the multivariate model, age, platelet count, and the proportion of PD1+TIM3+ double-positive CD4+ T cells differentiated a poor survival group. These results were validated by flow cytometry in a separate cohort (n = 31). In conclusion, the immune cell contexture in ALL BM differs from healthy controls. CD4+PD1+TIM3+ T cells were independent predictors of poor outcome in our multivariate risk model, suggesting that PD1 might serve as an attractive immuno-oncological target in B-ALL.
  • Velkova, Julia (2019)
    We are used to assuming that media infrastructures are made to last. This essay argues for taking impermanence as a point of departure in order to understand data centres’ power to reshape global and local peripheries into temporary nodes for value extraction, as well as the ways in which data centres influence the topography of global internet connectivity. By contrasting the discourses through which data centres are often represented in the media against their design and the wasteful materialities that underpin their operation, the essay opens up temporality and impermanence of data centres as a new theme for critical intervention that extends earlier discussions on the environmental impact of data centres, and their politics of territoriality.
  • Aitken, Mhairi; Tully, Mary Patricia; Porteous, Carol; Denegri, Simon; Cunningham-Burley, Sarah; Banner, Natalie; Black, Corri; Burgess, Michael; Cross, Lynsey; van Delden, J.H.; Ford, Elizabeth; Fox, Sarah; Fitzpatrick, N.K.; Gallacher, Kay; Goddard, Catherine; Hassan, Lamiece; Jamieson, Ron; Jones, Kerina H.; Kaarakainen, Minna Susanna; Lugg-Widger, Fiona; McGrail, Kim; McKenzie, Anne; Moran, Rosalyn; Murtagh, Madeleine J.; Oswald, Malcom; Paprica, Alison; Perrin, Nicola; Richards, Emma; Rouse, John; Webb, Joanne; Willison, Donald (2019)
    This consensus statement reflects the deliberations of an international group of stakeholders with a range of expertise in public involvement and engagement (PI&E) relating to data-intensive health research. It sets out eight key principles to establish a secure role for PI&E in and with the research community internationally and ensure best practice in its execution. Our aim is to promote culture change and societal benefits through ensuring a socially responsible trajectory for innovations in this field.
  • Giltaij, Jacob (Bloomsbury academic, 2019)
    Europe’s Legacy in the Modern World
  • NITEP-Grp; Launonen, Antti P.; Fjalestad, Tore; Laitinen, Minna K.; Lähdeoja, Tuomas; Ekholm, Carl; Wagle, Tone; Mattila, Ville M.; Sumrein, Bakir O.; Paloneva, Juha; Lehtimäki, Kaisa; Thillemann, Theis; Berg, Hans; Wolf, Olof (2019)
    Introduction The proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%-33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment. Methods This is a prospective, single-blinded, randomised, controlled, multicentre and multinational trial comparing RTSA with non-operative treatment in displaced proximal humeral fractures in patients 65-85 years. The primary outcome in this study is QuickDASH-score measured at 2 years. Secondary outcomes include visual analogue scale for pain, grip strength, Oxford shoulder score, Constant score and the number of reoperations and complications. The hypothesis of the trial is that operative treatment with RTSA produces better outcome after 2 and 5 years measured with QuickDASH. Ethics and dissemination In this protocol, we describe the design, method and management of the Nordic DeltaCon trial. The ethical approval for the trial has been given by the Regional Committee for Medical and Health Research Ethics, Norway. There have been several examples in orthopaedics of innovations that result in failure after medium-term follow-ups. In order to prevent such failures and to increase our knowledge of RSTA, we feel a large-scale study of the effects of the surgery on the outcome that focuses on the complications and reoperations is warranted. After the trial 2-year follow-up, the results will be disseminated in a major orthopaedic publication.
  • Laasik, Raul; Lankinen, Petteri; Kivimäki, Mika; Aalto, Ville; Saltychev, Mikhail; Mäkelä, Keijo; Vahtera, Jussi (2019)
    Background and purpose While the number of working-age patients undergoing total hip arthroplasty (THA) is increasing, the effect of the surgery on patients' return to work (RTW) is not thoroughly studied. We aimed to identify risk factors of RTW after THA among factors related to demographic variables, general health, health risk behaviors, and socioeconomic status.Patients and methods We studied 408 employees from the Finnish Public Sector (FPS) cohort (mean age 54 years, 73% women) who underwent THA. Information on demographic and socioeconomic variables, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of return to work was examined using Cox proportional hazard modeling.Results 94% of the patients returned to work after THA on average after 3 months (10 days to 1 year) of sickness absence. The observed risk factors of successful return to work were: having <30 sick leave days during the last year (HR 1.8; 95% CI 1.4-2.3); higher occupational position (HR 2.2; CI 1.6-2.9); and BMI <30 (HR 1.4; CI 1.1-1.7). Age, sex, preceding health status, and health-risk behaviors were not correlated with RTW after the surgery.Interpretation Most employees return to work after total hip arthroplasty. Obese manual workers with prolonged sick leave before the total hip replacement were at increased risk of not returning to work after the surgery.
  • Lont, Tonis; Nieminen, Jyrki; Reito, Aleksi; Pakarinen, Toni-Karri; Pajamäki, Ilari; Eskelinen, Antti; Laitinen, Minna K. (2019)
    Background and purpose Low-energy acetabulum fractures are uncommon, and mostly occur in elderly patients. Determining the optimal operative treatment for such fractures is challenging. Here we investigated whether acutely performed total hip arthroplasty plus posterior column plating (THA) reduced complications and reoperations compared with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures.Patients and methods We retrospectively reviewed the records of 59 patients, > 55 years of age, with complex acetabular fractures, caused by low-energy trauma, treated between January 2008 and September 2017. Of these patients, 34 underwent acute THA, and 25 ORIF alone. Patient and implant survival were compared between groups using Kaplan-Meier survival analysis and Cox multiple regression. Functional outcomes assessed by Oxford Hip Score (OHS) were compared between the THA patients and those 9 ORIF patients who underwent secondary THA due to posttraumatic hip osteoarthritis (OA) during follow-up.Results Overall patient survival was 90% (95% CI 82-98) at 12 months, and 64% (CI 47-81) at 5 years. Of 25 ORIF patients, 9 required secondary THA due to posttraumatic OA. Large fragments on the weight-bearing acetabular dome upon imaging predicted ORIF failure and secondary THA. The acute THA group and secondary THA group had similar 12-month OHS.Interpretation Acute THA including a reinforcement ring resulted in fewer reoperations than ORIF alone in elderly patients with acetabular fractures. These findings support acute THA as first-line treatment for complex acetabular fractures in elderly patients.
  • Bedard, Annabelle; Basagana, Xavier; Anto, Josep M.; Garcia-Aymerich, Judith; Devillier, Philippe; Arnavielhe, Sylvie; Bedbrook, Anna; Onorato, Gabrielle L.; Czarlewski, Wienczyslawa; Murray, Ruth; Almeida, Rute; Fonseca, Joao; Costa, Elisio; Malva, Joao; Morais-Almeida, Mario; Pereira, Ana Margarida; Todo-Bom, Ana; Menditto, Enrica; Stellato, Cristiana; Ventura, Maria Teresa; Cruz, Alvaro A.; Stelmach, Rafael; da Silva, Jane; Larenas-Linnemann, Desiree; Fuentes-Perez, Jose M.; Huerta-Villalobos, Yunuen R.; Emuzyte, Regina; Kvedariene, Violeta; Valiulis, Arunas; Kuna, Piotr; Samolinski, Boleslaw; Klimek, Ludger; Mosges, Ralph; Pfaar, Oliver; Shamai, Sara; Annesi-Maesano, Isabelle; Bosse, Isabelle; Demoly, Pascal; Fontaine, Jean-Francois; Cardona, Vicky; Mullol, Joaquim; Valero, Antonio; Roller-Wirnsberger, Regina E.; Tomazic, Peter Valentin; Chavannes, Niels H.; Fokkens, Wytske J.; Reitsma, Sietze; Bewick, Mike; Haahtela, Tari; Toppila-Salmi, Sanna (2019)
    Background: Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control. Objectives: A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR. Methods: A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H-1-antihistamines were studied. Results: Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H-1-antihistamines were found. Conclusions: This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
  • Kotaniemi, Karoliina V. M.; Heliövaara, Arja; Kotaniemi, Miika; Stoor, Patricia; Leikola, Junnu; Palotie, Tuula; Suojanen, Juho (2019)
    Background: Three-dimensionally (3D) designed osteotomies and customised osteosynthesis are rapidly becoming standard in maxillofacial reconstructive and deformity surgery. Patient-specific implants (PSIs) have been in use for a few years in orthognathic surgery as well. In Le Fort I osteotomy, wafer-free fixation of the maxillary segment can be performed by individually manufactured cutting and drill guides together with PSIs. Aim: This retrospective study was performed to compare the postoperative skeletal stability of the maxillary segment fixed by patient-specific implants versus mini-plates after Le Fort I osteotomy. Patients: Fifty-one patients were divided into subgroups according to the fixation method and the advancement of the sub-spinal point. The postoperative skeletal stability of the maxillary segment was evaluated from lateral cephalometric radiographs one year postoperatively. Results: No statistically significant differences were found between the postoperative skeletal stability of the PSI and mini-plate fixed maxillae. Prospective studies, possibly with 3D fusion analysis, are warranted to confirm the results. Conclusion: The choice between the two fixation methods does not seem to affect the postoperative skeletal stability of the maxillary segments. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
  • Almahmoudi, Rabeia; Salem, Abdelhakim; Murshid, Sakhr; Dourado, Mauricio Rocha; Apu, Ehsanul Hoque; Salo, Tuula; Al-Samadi, Ahmed (2019)
    We recently showed that extracellular interleukin-17F (IL-17F) correlates with better disease-specific survival in oral tongue squamous cell carcinoma (OTSCC) patients. However, the underlying mechanisms of such effect remain obscure. Here, we used qRT-PCR to assess the expression of IL-17F and its receptors (IL-17RA and IL-17RC) in two OTSCC cell lines (HSC-3 and SCC-25) and in normal human oral keratinocytes (HOKs). IL-17F effects on cancer cell proliferation, migration, and invasion were studied using a live-imaging IncuCyte system, and a Caspase-3/7 reagent was used for testing apoptosis. 3D tumor spheroids were utilized to assess the impact of IL-17F on invasion with or without cancer-associated fibroblasts (CAFs). Tube-formation assays were used to examine the effects of IL-17F on angiogenesis using human umbilical vein endothelial cells (HUVEC). OTSCC cells express low levels of IL-17F, IL-17RA, and IL-17RC mRNA compared with HOKs. IL-17F inhibited cell proliferation and random migration of highly invasive HSC-3 cells. CAFs promoted OTSCC invasion in tumor spheroids, whereas IL-17F eliminated such effect. IL-17F suppressed HUVEC tube formation in a dose-dependent manner. Collectively, we suggest that IL-17F counteracts the pro-tumorigenic activity in OTSCC. Due to its downregulation in tumor cells and inhibitory activity in in vitro cancer models, targeting IL-17F or its regulatory pathways could lead to promising immunotherapeutic strategies against OTSCC.
  • Eriksson, Daniel; Bacchetta, Rosa; Gunnarsson, Hordur Ingi; Chan, Alice; Barzaghi, Federica; Ehl, Stephan; Hallgren, Åsa; van Gool, Frederic; Sardh, Fabian; Lundqvist, Christina; Laakso, Saila M.; Rönnblom, Anders; Ekwall, Olov; Mäkitie, Outi; Bensing, Sophie; Husebye, Eystein S.; Anderson, Mark; Kampe, Olle; Landegren, Nils (2019)
  • Sallinen, Hanne; Sairanen, Tiina; Strbian, Daniel (2019)
    Objectives: Quality of life (QoL) after intracerebral hemorrhage (ICH) is poorly known. This study investigated factors affecting QoL and depression after spontaneous ICH. Materials and Methods: This prospective study included patients admitted to Helsinki University Hospital between May 2014 and December 2016. Health-related QoL (HRQoL) at 3 months after ICH was measured using the European Quality of Life Scale (EQ-5D-5L), and the 15D scale. Logistic regression analyses were used to test factors affecting HRQoL. EQ-5D-5L anxiety/depression dimension was used to analyze factors associated with anxiety/depression. Results: Of 277 patients, 220 were alive, and sent QoL questionnaire. The questionnaire was returned by 124 patients. Nonreturners had more severe strokes with admission National Institutes of Health Stroke Scale (NIHSS) 7.8 (IQR 3.0-14.8) versus 5.0 (IQR 2.3-11.0); p = 0.018, and worse outcome assessed as modified Rankin Scale 3-5 at 3 months 59.4% versus 44.4% (p = 0.030). Predictors for lower HRQoL by both scales were higher NIHSS with OR 1.28 (95% CI 1.13-1.46) for EQ-5D-5L, and OR 1.28 (1.15-1.44) for 15D, older age (OR 1.10 [1.03-1.16], and OR 1.09 [1.03-1.15]), and chronic heart failure (OR 18.12 [1.73-189.27], and OR 12.84 [1.31126.32]), respectively. Feeling sad/depressed for more than 2 weeks during the year prior to ICH was predictor for lower EQ-5D-5L (OR 10.64 [2.39-47.28]), and history of ICH for lower 15D utility indexes (OR 11.85 [1.01-138.90]). Prior feelings of sadness/ depression were associated with depression/anxiety at 3 months after ICH with OR 3.62 (1.14-11.45). Conclusions: In this cohort of ICH patients with milder deficits, HRQoL was affected by stroke severity, comorbidities and age. Feelings of depression before ICH had stronger influence on reporting depression/anxiety after ICH than stroke severity-related and outcome parameters. Thus, simple questions on patient's premorbid feelings of sadness/depression could be used to identify patients at risk of depression after ICH for focusing follow-up and treatment.
  • Mattila, Simo; Waris, Eero (2019)
    Background and purpose - Revision surgery after trapeziometacarpal arthroplasty is sometimes required. Varying revision rates and outcomes have been reported in rather small patient series. Data on risk factors for revision surgery, on the final outcome of revision, and possible factors affecting the outcome of revision are also limited. We evaluated these factors in 50 patients.Patients and methods - From 1,142 trapeziometacarpal arthroplasties performed during a 10-year period, 50 patients with 65 revision surgeries were retrospectively identified and invited to participate in a follow-up study involving subjective, objective, and radiologic evaluation. The revision rate, risk factors for revision, and factors affecting the outcome of revision were analyzed.Results - The revision rate was 5%. Scaphometacarpal impingement was the most common reason for revision surgery. Patient age ≤ 55 years was a risk factor with a revision rate of 9% in this age group, whereas an operation on both thumbs during the follow-up period was a negative risk factor for revision surgery. There was no difference in revision risk between ligament reconstruction and tendon interposition with or without a bone tunnel. 9 patients had multiple revision procedures and their final outcome did not differ significantly from patients revised only once. Most of the patients felt subjectively that they had benefited from revision surgery and the subjective outcome measures (QuickDash and pain VAS) and the Conolly score were in the same range as previously described for revision trapeziometacarpal arthroplasty.Interpretation ? Age ≤ 55 years is a risk factor for revision surgery. The type of primary surgery does not affect the risk of revision surgery and multiple revision procedures do not result in worse outcomes than cases revised only once. Mechanical pain caused by contact between the metacarpal and scaphoid is the most common indication for revision surgery. In general, patients seem to benefit from revision surgery for trapeziometacarpal osteoarthritis.
  • Zhang, Luyao; Hemminki, Otto; Chen, Tianhui; Yu, Hongyao; Zheng, Guoqiao; Chattopadhyay, Subhayan; Försti, Asta; Sundquist, Kristina; Sundquist, Jan; Hemminki, Kari (2019)
    While treatment for testicular cancer (TC) has become standardized after the 1980s with an associated significant improvement in patient survival, this has been accompanied by an increased risk of second primary cancers (SPCs). Patients were identified from the Swedish Cancer Registry spanning the years from 1980 to 2015, including 8788 individuals with primary TC and their SPCs. Relative risks (RRs) for SPC were calculated using the generalized Poisson regression model. SPCs were diagnosed in 9.4% of patients with TC and half of them were late onset cancers not common in the population in their 40s. Overall RR of SPCs (excluding second TC) was 1.30 (95%CI: 1.20-1.40), including high risks for seven solid cancers, non-Hodgkin lymphoma and leukemia. Second TC was the most common SPC and the RR of 17.19 (95%CI: 14.89-19.85) was the highest recorded. Cancers known to be fatal as first primary cancers were also fatal as SPC in TC patients. Survival at 30 years of follow-up was approximately 80% for TC patients without SPC but it decreased to 40% for patients with SPC. The unexpected finding that half of the identified SPCs were typical late onset cancers in the middle-aged population raises concerns that therapy may facilitate premature aging. The risks of SPC are clinically important for the long-term management of TC patients and the high-mortality calls for a future management strategy.
  • Ellis, L. T.; Amélio, L. A.; Peralta, D. F.; Bačkor, M.; Baisheva, E. Z.; Bednarek-Ochyra, H.; Burghardt, M.; Czernyadjeva, I. V.; Kholod, S. S.; Potemkin, A. D.; Erdağ, A.; Kırmacı, M.; Fedosov, V. E.; Ignatov, M. S.; Koltysheva, D. E.; Flores, J. R.; Fuertes, E.; Goga, M.; Guo, S.-L.; Hofbauer, W. K.; Kurzthaler, M.; Kürschner, H.; Kuznetsova, O. I.; Lebouvier, M.; Long, D. G.; Mamontov, Yu. S.; Manjula, K. M.; Manju, C. N.; Mufeed, B.; Müller, F.; Nair, M. C.; Nobis, M.; Norhazrina, N.; Aisyah, M.; Lee, G. E.; Philippe, M.; Philippov, D. A.; Plášek, V.; Komínková, Z.; Porley, R. D.; Rebriev, Yu. A.; Sabovljević, M. S.; de Souza, A. M.; Valente, E. B.; Spitale, D.; Srivastava, P.; Sahu, V.; Asthana, A. K.; Ştefănuţ, S.; Suárez, G. M.; Vilnet, A. A.; Yao, K.-Y.; Zhao, J.-Ch. (2019)
  • Parhi, Katariina (2019)
    This article analyses interpretations of the causes of children's behavioural problems in early child psychiatry in Finland from the 1920s until the 1950s. The era was pre-psychodynamic, and psychiatrists stressed biological explanations, which were based on hereditary factors. The source material consists of patient records of children diagnosed with psychopathy in Pitkaniemi Hospital, which operated as one of the state mental hospitals. The focus is on the ways in which the causes of behavioural problems were described, paying special attention to mentions of socioeconomic factors, and adopting a present-centred perspective on analysing the past. Although psychiatrists described details like family background and parental occupations, they did not necessarily use them to point out connections between socioeconomic factors and behavioural problems. On the contrary, in many cases, there was no indicated correlation. This is not to say that socioeconomic factors did not exist or were not acknowledged, but rather that they were discussed in a different light. The assumption of biologically oriented psychiatry, namely that behavioural problems were primarily hereditary, is prevalent in the case records. Some children improved while in hospital and subsequently returned home, or were placed with other families, or in children's homes. Those who were perceived to be permanently antisocial were placed in reform schools. The change in a child's behaviour seems to have been crucial in forming a prognosis, which implies that there was a clear belief in the curative atmosphere of the hospital, providing that the child's character was corrigible. The focus on socioeconomic factors contrasts with the ways in which psychiatrists at that time perceived and documented the causes of behavioural problems, and helps explain why something, which seems evident in retrospect, was not apparent at the time.
  • Muhammad, Sajjad; Niemelä, Mika (2019)
    Current treatment modalities for the treatment of intracranial aneurysms including surgical clipping and endovascular coiling are invasive and have some treatment risks. Since not all aneurysms rupture, it is critical to detect rupture prone aneurysms. Molecular and cellular analysis of aneurysm tissue may provide understanding about pathobiology of aneurysm rupture and to develop imaging techniques to detect rupture prone aneurysms. For more than 15-years we have collected samples to identify pathological processes in the aneurysm wall itself predisposing to rupture. This has opened a new field of research leading to novel findings and multiple scientific publications. Surgical techniques of sampling the aneurysm dome have never been demonstrated so therefore many neurosurgeons are reluctant to take biopsies for research. Now we demonstrate with an intraoperative video the techniques of sampling the aneurysm dome after clipping an incidental right-sided 5-mm unruptured MCA aneurysm in a 58-year-old hypertensive male with past long history of smoking through lateral supraorbital approach. A focused opening of the Sylvian fissure was performed and the aneurysm was clipped using standard techniques. After placement of a titanium clip, ICG and Doppler were performed to ensure patency of both M2 vessels and the aneurysm was punctured. The aneurysm dome was then held in place with the suction and cut with microscissors for research purposes. Another titanium clip was placed (Video 1). The clinical course was uneventful. This technical note will help young neurosurgeons to contribute actively in aneurysm research also potentially to find non-invasive methods to prevent aneurysms from rupture.

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