Immuuniaktivaation vapauttajien, kaksoisspesifisten vasta-aineiden ja CAR-T-soluhoitojen sydänhaitat

Immuuniaktivaation vapauttajia, kaksoisspesifisiä vasta-aineita ja CAR-T-soluhoitoja käytetään syöpäpotilaiden hoidossa yhä enemmän. Immuuniaktivaation vapauttajien aiheuttamat sydänhaitat, kuten myokardiitti, perikardiitti, sydäninfarkti, rytmihäiriöt ja sydämen vajaatoiminta ovat harvinaisia. Diabetes, tupakointi, aiemmat sydäntoksiset syöpähoidot sekä sydän- ja verisuonitaudit saattavat lisätä immuuniaktivaation vapauttajilla hoidettavien potilaiden sydänhaittariskiä. Kaksoisspesifiset vasta-aineet ja CAR-T-soluhoidot aiheuttavat antamisen jälkeen yleisesti elimistöön sytokiinimyrskyn. Se voi aiheuttaa verenpaineen laskua, rytmihäiriöitä, sydämen vajaatoimintaa ja sydänperäisiä äkkikuolemia. Kaksoisspesifisiä vasta-aineita ja CAR-T-soluhoitoja saaneita potilaita seurataan tiiviisti sairaalassa hoidon jälkeen. Haittavaikutusten varhainen tunnistaminen voi pelastaa potilaan hengen

Immuuniaktivaation vapauttajien, kaksoisspesifisten vasta-aineiden ja CAR-T-soluhoitojen sydänhaitat

Immuuniaktivaation vapauttajia, kaksoisspesifisiä vasta-aineita ja CAR-T-soluhoitoja käytetään syöpäpotilaiden hoidossa yhä enemmän. Immuuniaktivaation vapauttajien aiheuttamat sydänhaitat, kuten myokardiitti, perikardiitti, sydäninfarkti, rytmihäiriöt ja sydämen vajaatoiminta ovat harvinaisia. Diabetes, tupakointi, aiemmat sydäntoksiset syöpähoidot sekä sydän- ja verisuonitaudit saattavat lisätä immuuniaktivaation vapauttajilla hoidettavien potilaiden sydänhaittariskiä. Kaksoisspesifiset vasta-aineet ja CAR-T-soluhoidot aiheuttavat antamisen jälkeen yleisesti elimistöön sytokiinimyrskyn. Se voi aiheuttaa verenpaineen laskua, rytmihäiriöitä, sydämen vajaatoimintaa ja sydänperäisiä äkkikuolemia. Kaksoisspesifisiä vasta-aineita ja CAR-T-soluhoitoja saaneita potilaita seurataan tiiviisti sairaalassa hoidon jälkeen. Haittavaikutusten varhainen tunnistaminen voi pelastaa potilaan hengen.publishedVersionPeer reviewe

The utilization of primary healthcare services among frail older adults - findings from the Helsinki Birth Cohort Study

Background The impact of frailty on primary healthcare service use, especially general practice office visits and remote contacts, is currently unknown. Further, little is known about the association of frailty with physiotherapy contacts. Methods We examined the utilization of primary healthcare services among 1064 participants from the Helsinki Birth Cohort Study between the years 2013 and 2017. Frailty was assessed based on Fried's frailty criteria at mean age of 71.0 (2.7 SD) years in clinical examinations between the years 2011 and 2013. General practice office visits and remote contacts, the total number of general practice contacts, physiotherapy contacts, and the total number of primary healthcare contacts were extracted from a national Finnish register. We analyzed the data with negative binomial regression models. Results Of the 1064 participants, 37 were frail (3.5%) and 427 pre-frail (40.1%); 600 non-frail (56.4%) served as a reference group. Frailty was associated with general practice office visits (IRR 1.31, 95% CI=1.01-1.69), physiotherapy contacts (IRR 2.97, 95% CI=1.49-5.91) and the total number of primary healthcare contacts (IRR 1.41, 95% CI=1.07-1.85). Pre-frailty predicted the use of general practice remote contacts (IRR 1.39, 95% CI=1.22-1.57) and the total number of general practice contacts (IRR 1.25, 95% CI=1.12-1.40). Conclusions Frailty increases the overall primary healthcare service use whereas pre-frailty is associated with the use of general practice services, especially remote contacts. Primary healthcare needs measures to adapt healthcare services based on the needs of rapidly increasing number of pre-frail and frail older adults and should consider preventative interventions against frailty.Peer reviewe

Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI

OBJECTIVES We aimed to investigate whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) associate with histological aggressiveness of ovarian cancer (OC) or predict the clinical outcome. This prospective study enrolled 40 patients with primary OC, treated 2011-2014. METHODS DWI was performed prior to surgery. Two observers used whole lesion single plane region of interest (WLsp-ROI) and five small ROIs (S-ROI) to analyze ADCs. Samples from tumours and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors. RESULTS The interobserver reliability of ADC measurements was excellent for primary tumours ICC 0.912 (WLsp-ROI). Low ADCs significantly associated with poorly differentiated OC (WLsp-ROI P = 0.035). In primary tumours, lower ADCs significantly associated with high Ki-67 (P = 0.001) and low VEGF (P = 0.001) expression. In metastases, lower ADCs (WLsp-ROI) significantly correlated with low VEGF receptors mRNA levels. ADCs had predictive value; 3-year overall survival was poorer in patients with lower ADCs (WLsp-ROI P = 0.023, S-ROI P = 0.038). CONCLUSION Reduced ADCs are associated with histological severity and worse outcome in OC. ADCs measured with WLsp-ROI may serve as a prognostic biomarker of OC. KEY POINTS • Reduced ADCs correlate with prognostic markers: poor differentiation and high Ki-67 expression • ADCs also significantly correlated with VEGF protein expression in primary tumours • Lower ADC values are associated with poorer survival in ovarian cancer • Whole lesion single plane-ROI ADCs may be used as a prognostic biomarker in OC

Radiological and pathological assessment of response to neoadjuvant CDK4/6 inhibitor and endocrine treatments in a real-life setting : initial results

publishedVersionPeer reviewe

Breast density and the likelihood of malignant MRI-detected lesions in women diagnosed with breast cancer

Objectives: To assess whether mammographic breast density in women diagnosed with breast cancer correlates with the total number of incidental magnetic resonance imaging (MRI)-detected lesions and the likelihood of the lesions being malignant. Methods: Patients diagnosed with breast cancer meeting the EUSOBI and EUSOMA criteria for preoperative breast MRI routinely undergo mammography and ultrasound before MRI at our institution. Incidental suspicious breast lesions detected in MRI are biopsied. We included patients diagnosed with invasive breast cancers between 2014 and 2019 who underwent preoperative breast MRI. One reader retrospectively determined breast density categories according to the 5th edition of the BI-RADS lexicon. Results: Of 946 patients with 973 malignant primary breast tumors, 166 (17.5%) had a total of 175 (18.0%) incidental MRI-detected lesions (82 (46.9%) malignant and 93 (53.1%) benign). High breast density according to BI-RADS was associated with higher incidence of all incidental enhancing lesions in preoperative breast MRIs: 2.66 (95% confidence interval: 1.03–6.86) higher for BI-RADS density category B, 2.68 (1.04–6.92) for category C, and 3.67 (1.36–9.93) for category D compared to category A (p < 0.05). However, high breast density did not predict higher incidence of malignant incidental lesions (p = 0.741). Incidental MRI-detected lesions in the contralateral breast were more likely benign (p < 0.001): 18 (27.3%)/48 (72.7%) vs. 64 (58.7%)/45 (41.3%) malignant/benign incidental lesions in contralateral vs. ipsilateral breasts. Conclusion: Women diagnosed with breast cancer who have dense breasts have more incidental MRI-detected lesions, but higher breast density does not translate to increased likelihood of malignant incidental lesions. Clinical relevance statement: Dense breasts should not be considered as an indication for preoperative breast MRI in women diagnosed with breast cancer. Key Points: • The role of preoperative MRI of patients with dense breasts diagnosed with breast cancer is under debate. • Women with denser breasts have a higher incidence of all MRI-detected incidental breast lesions, but the incidence of malignant MRI-detected incidental lesions is not higher than in women with fatty breasts. • High breast density alone should not indicate preoperative breast MRI.Peer reviewe

Isolated sternal fracture after low-energy trauma in a geriatric patient : a case report

Background: Falls are a common cause of emergency department (ED) visits for the older population. If osteoporosis is present, even falls from standing height can lead to unusual fractures normally associated with high-energy trauma. In this report, we analyze a rare case of an isolated sternal fracture with an unusual mechanism of injury. Our discussion aims to improve care for older adults with fall-related fractures. Case presentation: An 86-year-old female presented in the ED of our hospital with a complaint of chest pain. She recalled a fall at home the previous day and described how her fist was impacted between the floor and her chest. A physical examination revealed local tenderness in the mid-chest. A lateral chest x-ray indicated a sternal fracture, and a chest computed tomography scan ruled out concomitant injuries. There were no acute changes on her electrocardiogram (ECG). Conservative outpatient treatment was started, and referrals were made with a recommendation to initiate fall prevention measures and osteoporosis screening in primary health care. Conclusions: Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries. An in-depth physical examination and an understanding of the exact mechanism of injury are important to avoid missing fractures in unexpected locations. Modern ED physicians could have an important role in the secondary prevention of fall-related fractures for geriatric patients.publishedVersionNon peer reviewe

The future of computing paradigms for medical and emergency applications

Healthcare is of particular importance in everyone’s life, and keeping the advancement of it on a good pace is a priority of any country, as it highly influences the overall well-being of its citizens. Each government strives to build a modern, intelligent medical system that provides maximum population coverage with high-quality medical services. The development of Information and Communication Technologies (ICT) significantly improves the accessibility and effectiveness of the healthcare system by forming the eHealth environment, thus, providing an opportunity to enhance the quality of patient care and significantly speed up the work of medical experts and reduce costs for medical services. Shifting medical services to digital and remote operations requires a lot of computational capabilities. Implementing new computing paradigms is prominent — remote services face new requirements due to the increasing data and demand for new computing solutions. Computing paradigms, e.g., Cloud, Edge, Mobile Edge Computing, besides others, are used to process the collected medical data, improving patient healthcare quality. This paper focuses on computing solutions for medical use cases by offering a comprehensive survey on standardization aspects, use cases, applicable computing paradigms, security limitations, and design considerations within the ICT usages for medical applications. Finally, it outlines the most critical integration challenges and solutions from the literature.publishedVersionPeer reviewe

Chronic unilateral groin pain in a young patient who injects drugs : a case report of needle fragment retentions

Background: Subcutaneously retained needle fragments in people who inject drugs (PWIDs) are a possible cause of local symptoms, most commonly pain and infections. It remains unknown how common retained needle fragments are among PWIDs. Case presentation: A young PWID consulted a primary care physician due to chronic left-sided groin pain. The patient suspected retention of a broken needle as the cause. She had used a re-used needle 3 months earlier. A plain pelvic radiograph confirmed a needle fragment in the patient's left groin, and a computed tomography scan located it adjacent to the femoral artery and vein. Another asymptomatic needle fragment was found in the right groin. Conclusion: Needle fragments are possible causes of local symptoms among PWIDs. The clinical examination presents a potential risk of needlestick injury to the examiner, especially because patients may not be aware of all needle fragments as some are asymptomatic.publishedVersionNon peer reviewe

Is there a role for contrast-enhanced ultrasound in the detection and biopsy of MRI only visible breast lesions?

This study aimed to evaluate the feasibility of contrast-enhanced ultrasound (CEUS) and CEUS-guided interventions in the diagnostics of MRI visible targeted US occult breast lesions