Opas rintaleikkauspotilaalle : potilasohje Tampereen yliopistollisen sairaalan tuki- ja liikuntaelinkirurgian poliklinikalle

Rintasyöpäkirurgia on kehittynyt paljon viime vuosikymmenien aikana ja nykyään suositaan rintaa säästävää leikkausta yhdistettynä onkologisiin hoitoihin. Rintarekonstruk-tiomenetelmät ovat monipuolisia ja niillä saavutetaan hyviä tuloksia. Rintarekonstruktio voidaan tehdä käyttämällä potilaan omaa selkäkielekettä, vatsakielekettä tai implanttia ja pienentämällä toista rintaa symmetrian aikaansaamiseksi. Rintasyöpäleikkauksen jälkeen imusolmukkeiden poiston jälkeen potilaalle voi tulla lymfaturvotusta, jota on tarpeen hoitaa fysioterapeuttisin keinoin. Erilaiset liikeharjoitukset auttavat monia rintaleikattuja palautumaan leikkauksesta. Tämän opinnäytetyön tarkoituksena oli tuottaa potilasohje Tampereen yliopistollisen sairaalan tuki- ja liikuntaelinpoliklinikalle. Opinnäytetyö oli työelämälähtöinen. Ohje suunnattiin rintarekonstruktiopotilaille ja rinnan pienennysleikkaukseen tulijoille. Ohje toteutettiin yhteistyössä poliklinikan henkilökunnan kanssa ja ohjeessa kiinnitettiin eri-tyistä huomiota fysioterapiaan. Ulkoasultaan sairaalan ohjeiden mukainen opas sisältää liikeharjoituskuvat ja ohjeet. Näiden lisäksi oppaassa on tietoa siitä, kuinka leikkaukseen voi valmistautua ja mitä toipumisaikana tulee ottaa huomioon. Potilasohjeen tavoitteena oli vastata potilaan kysymyksiin sekä olla apuna leikkauksen valmistautumis- ja toipumisvaiheessa. Opinnäytetyö tehtiin toiminnallista menetelmää käyttäen.Breast surgery techniques have developed a lot during past decades. Reconstructive surgery methods are wide and they have a lot of opportunities. Often the results are really good too. In reconstructive breast surgery the removable flap can be taken either from patient´s back muscle or from the patient´s lower tummy tissue using fat, muscle and blood veins in that area. Also an implant can be used and the remaining healthy breast can be reduced smaller so the result looks more symmetrical. If it is necessary to remove lymph nodes in the surgery, it is possible that the patient will suffer of lymph swallowing. Swallowing needs to be treated with physiotherapy. Different physiotherapeutic exercises after the surgery help the patient to recover. The purpose of this thesis was to create a patient leaflet for the Musculoskeletal Disease Surgery Outpatient Clinic in Tampere University Hospital. The leaflet was compiled for patients who have reconstructive surgery or breast reduction. The leaflet was designed and made in co-operation with the workers of the clinic. There are physiotherapeutic exercises in the guide including instructions and drawings. The leaflet also gives infor-mation on how to prepare for the surgery and what is important after it. The leaflet will be printed and it will be available for the patients in summer or in autumn 2016

Synnynnäinen lonkkaluksaatio

Vertaisarvioitu.Lonkan epätukevuus on tavallisin vastasyntyneen tukirankapoikkeavuus. Suurin osa vastasyntyneiden epätukevista lonkista tukevoituu itsestään. Kuuden viikon pituinen lastahoito aloitetaan, ellei lonkka ole tukevoitunut kahden viikon ikään mennessä. Lastahoidolla lonkasta tulee yleensä normaali. Lonkkaluksaatio voi kehittyä syntymän jälkeen tai diagnoosi voi viivästyä, mikä vaikeuttaa ja pitkittää hoitoa. Vastasyntyneellä todetun lonkkaluksaation hoitotulokset ovat hyviä, myöhään todettu lonkkaluksaatio taas johtaa lähes puolella potilaista tekonivelleikkaukseen aikuisiässä

Reduced Number of Pediatric Orthopedic Trauma Requiring Operative Treatment during COVID-19 Restrictions: A Nationwide Cohort Study

Cited by: 28; All Open Access, Green Open AccessPeer reviewe

Reduced Number of Pediatric Orthopedic Trauma Requiring Operative Treatment during COVID-19 Restrictions: A Nationwide Cohort Study

Cited by: 28; All Open Access, Green Open AccessPeer reviewe

Cast immobilisation in situ versus open reduction and internal fixation of displaced medial epicondyle fractures in children between 7 and 16 years old. A study protocol for a randomised controlled trial

Introduction Medial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation 2 mm dislocation without joint incarceration or ulnar nerve dysfunction. We hypothesise that there is no difference in treatment outcomes between nonoperative and operative treatment.Methods and analysis This is a multicentre, controlled, prospective, randomised noninferiority study comparing operative treatment to non-operative treatment of >2 mm dislocated paediatric medial epicondyle fractures without joint incarceration or ulnar nerve dysfunction. A total of 120 patients will be randomised in 1:1 ratio to either operative or nonoperative treatment. The study will have a parallel nonrandomised patient preference arm. Operative treatment will be open reduction and internal fixation. Nonoperative treatment will be upper limb immobilisation in long arm cast for 4 weeks. Data will be collected at baseline and at each follow-up up to 2 years. Quick-DASH is used as primary outcome measure. Secondary outcomes are patient-reported pain, differences in range of motion, Pediatric Quality of Life Inventory, cosmetic visual analogue scale and Mayo Elbow Performance Score.Ethics and dissemination Ethical approval has been obtained from Helsinki University Hospital (HUS) ethical board HUS/1443/2019. Each study centre has obtained their own permission for the study. A written authorisation from legal guardian will be acquired and the child will be informed about the trial. Results of the trial will be disseminated as published articles in peer-reviewed journals.</div

Preclinical Evaluation of a Humanized Antibody Against Common Lymphatic Endothelial and Vascular Endothelial Receptor-1, 89Zr-Desferrioxamine-Bexmarilimab, in a Rabbit Model of Renal Fibrosis

Bexmarilimab is a new humanized monoclonal antibody against common lymphatic endothelial and vascular endothelial receptor-1 (CLEVER-1), and is in clinical trials for macrophage-guided cancer immunotherapy. In addition to cancer, CLEVER-1 is also associated with fibrosis. To facilitate prospective human PET studies, we preclinically evaluated 89Zr-labeled bexmarilimab in rabbits. Methods: Bexmarilimab was conjugated with desferrioxamine (DFO) and radiolabeled with 89Zr. Retained immunoreactivity was confirmed by flow cytometry. Distribution kinetics of intravenously administered 89Zr-DFO-bexmarilimab (0.1 mg/kg) for up to 7 days in a rabbit model of renal fibrosis mediated by unilateral ureteric obstruction (UUO). The in-vivo stability of 89Zr-DFO-bexmarilimab was evaluated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis in combination with autoradiography. Additionally, we estimated the human radiation dose from data obtained in healthy rabbits. Results: 89Zr-DFO-bexmarilimab cleared rapidly from the blood circulation and distributed to the liver and spleen. At 24 hours post-injection, PET/CT, ex-vivo gamma counting and autoradiography demonstrated that there was significantly higher 89Zr-DFO-bexmarilimab uptake in UUO-operated fibrotic renal cortex, characterized by abundant CLEVER-1-positive cells, than in contralateral or healthy kidneys. The estimated effective dose for a 70-kg human was 0.70 mSv/MBq. Conclusion: The characteristics of 89Zr-DFO-bexmarilimab support future human PET studies to, for example, stratify patients for bexmarilimab treatment, evaluate the efficacy of treatment, or monitor disease progression.</p

Efficacy and tolerability of folate-aminopterin therapy in a rat focal model of multiple sclerosis

BackgroundActivated macrophages in the experimental model of multiple sclerosis (MS) express folate receptor-beta (FR-beta), representing a promising target for the treatment of MS. Here, we both evaluated the efficacy of a novel folate-aminopterin construct (EC2319) in a rat focal model of multiple sclerosis (MS) and investigated the utility of Ga-68-labeled 1,4,7-triazacyclononane-1,4,7-triacetic acid-conjugated folate (Ga-68-FOL) for assessing inflammatory lesions. In addition, we investigated whether FR-beta is expressed in the brain of patients with MS.MethodsFocal delayed-type hypersensitivity experimental autoimmune encephalomyelitis (fDTH-EAE) was induced in 40 Lewis rats; 20 healthy Lewis rats were used as controls. Rats were divided into six groups according to the duration of disease (control, acute, or chronic) and intervention (vehicle versus EC2319). Ga-68-FOL analyses, histology, and immunofluorescence of the brain were performed to evaluate the efficacy of subcutaneously administered EC2319 on lesion development. Immunofluorescence was used to assess FR-beta expression in postmortem brain samples from 5 patients with MS and 5 healthy controls.ResultsImmunofluorescence and histological analyses revealed significant reductions in FR-beta expression (P < 0.05) and lesion size (P < 0.01), as well as improved inducible nitric oxide synthase/mannose receptor C type 1 ratios (P < 0.01) in macrophages and microglia during the chronic but not acute phase of fDTH-EAE in EC2319-treated rats. The uptake of IV-injected Ga-68-FOL in the brain was low and did not differ between the groups, but the in vitro binding of Ga-68-FOL was significantly lower in EC2319-treated rats (P < 0.01). FR-beta positivity was observed in chronically active lesions and in normal-appearing white matter in MS brain samples.ConclusionsEC2319 was well tolerated and attenuated inflammation and lesion development in a rat model of a chronic progressive form of MS. Human MS patients have FR-beta -positive cells in chronically active plaques, which suggests that these results may have translational relevance

Effect of remdesivir post hospitalization for COVID-19 infection from the randomized SOLIDARITY Finland trial

We report the first long-term follow-up of a randomized trial (NCT04978259) addressing the effects of remdesivir on recovery (primary outcome) and other patient-important outcomes one year after hospitalization resulting from COVID-19. Of the 208 patients recruited from 11 Finnish hospitals, 198 survived, of whom 181 (92%) completed follow-up. At one year, self-reported recovery occurred in 85% in remdesivir and 86% in standard of care (SoC) (RR 0.94, 95% CI 0.47-1.90). We infer no convincing difference between remdesivir and SoC in quality of life or symptom outcomes (p > 0.05). Of the 21 potential long-COVID symptoms, patients reported moderate/major bother from fatigue (26%), joint pain (22%), and problems with memory (19%) and attention/concentration (18%). In conclusion, after a one-year follow-up of hospitalized patients, one in six reported they had not recovered well from COVID-19. Our results provide no convincing evidence of remdesivir benefit, but wide confidence intervals included possible benefit and harm.Peer reviewe

Ravitsemus keinona sisäilmasta sairastuneen selviytymisessä

Sisäilmasta sairastuneen oireiden kirjo on laaja. Oireet voivat olla lieviä, vakavia tai jopa elämänlaatua heikentäviä. Nykyisin ihmisen immuniteettiä kuormittavat monet tekijät, kuten kosteusvauriomikrobit ja niiden toksiinit, kemikaalit, erilaiset haihtuvat orgaaniset yhdisteet, antibioottikuurit sekä haitalliset ruoka-aineet. Tietynlaisella ravitsemuksella ja suolistomikrobeilla tiedetään olevan positiivisia vaikutuksia ihmisen vastustuskykyyn. Opinnäytetyön tarkoituksena oli kuvata sisäilmasta sairastuneiden ihmisten kokemuksia ravitsemuksen merkityksestä selviytymisessä. Tavoitteena oli tuottaa konkreettista tietoa ravitsemuksen merkityksestä sisäilmasta sairastuneen henkilön terveyden edistämiseksi. Tutkimuskysymys oli, miten koet ravitsemuksen auttavan sisäilmasta sairastumisen jälkeen selviytymisessä? Aineiston keruumenetelmänä käytettiin teemahaastattelua. Haastatteluja tehtiin kymmenen ja ne toteutettiin elo-syyskuun aikana vuonna 2019. Haastateltavilla oli henkilökohtaista kokemusta sisäilmasta sairastumisesta ja ravitsemuksesta sen oireiden lievittämisessä. Aineisto analysoitiin induktiivis-deduktiivisesti. Aineistosta ilmeni ravitsemuksella olleen merkittävä vaikutus oireiden lievenemiseen sekä yleiseen jaksamiseen. Terveyttä edistävää ravitsemusta koettiin olevan muun muassa terveellinen säännöllinen ruokavalio, kasvisten ja marjojen runsas määrä. Tuloksissa ilmeni terveyttä heikentäviä seikkoja olleen gluteeni ja sokerit sekä jatkuvat antibioottihoidot. Haastateltavat toivat ilmi erilaisia hiven- ja kivennäisaineita sekä vitamiineja, joiden he kokivat edistävän terveyttä. Tutkimuksia ravitsemuksen vaikutuksista sisäilmasairauksiin ei juurikaan ole. Tulosten perusteella viitteitä tästä kuitenkin löytyy, joten tutkimus erilaisilla menetelmillä on tarpeen tulevaisuudessa. Lisätutkimuksen avulla voitaisiin löytää ja tunnustaa paremmin sisäilmasta sairastumiseen liittyviä oireita sekä liitännäissairauksia. Lisääntyneen tiedon avulla voidaan tukea paremmin elimistön optimaalista toimintaa ravitsemuksen keinoin ja siten vaikuttaa sisäilmasairauksiin ja niiden oireisiin.People who suffer from indoor air sickness experience an extensive variety of symptoms. The symptoms can be minor, severe or they can even degrade the quality of life. Today the human immune system is being strained by many things, such as microbes affiliated with water damage and their toxins, chemicals, different volatile organic compounds, antibiotics and harmful nutrition. Specific nutriments and human gastrointestinal microbiota are known to have positive effects on the human immune system. The purpose of this thesis was to describe the experiences of people suffering from indoor air sickness, more specifically their views on nutrition as a means of coping. The aim was to produce concrete information about the meaning of nutrition, and its effect on the health of a person, who has become sick from indoor air. The research question was, how does nutrition help after being exposed to indoor air sickness? The information was gathered with theme interviews. A total of 10 interviews were conducted during August and September 2019. The interviewees had personal experiences in exposure to indoor air sickness and nutrition as a means of mitigating the symptoms. The material was analyzed using inductive and deductive content analysis. The material showed nutrition had a significant role in mitigating the symptoms, as well as overall wellness. A healthy and regular diet, abundance of berries and vegetables were seen to have beneficial effects on health. The results also showed that gluten, sugars and frequent antibiotic treatments had a detrimental impact on health. The interviewees brought up a variety of minerals, micronutrients and vitamins that they thought had an advantageous impact on health. There is not much research on the effects of nutrition on indoor air sickness. However, based on the results, similarities are found here, so research using different methods is needed in the future. Further research could help find and recognize symptoms related to indoor air sickness and comorbidities. Increased knowledge can better support the optimal function of the body with nutrition and thus impact indoor air sickness and symptoms

Controlled Outcomes for Achievement of Urinary Continence among Boys Treated for Posterior Urethral Valves

Purpose: We evaluated the age at which boys with a history of posterior urethral valves after no or minimal anticholinergic medication achieve urinary continence and the factors contributing to continence. Materials and Methods: We reviewed the hospital records of all males treated for posterior urethral valves at a single institution between 1990 and 2008. Continence was considered to have been attained if no weekly wetting episodes occurred. We evaluated the influence of patient characteristics, including reduced kidney function and primary ring type ureteral stoma, on age at which continence was achieved. Results: A total of 76 patients were assessed. Achievement of daytime and nighttime urinary continence was markedly delayed in patients (mean +/- SD age 5.5 +/- 3.3 years and 5.4 +/- 3.0 years, respectively) compared to the reference population (2.3 +/- 0.5 and 2.9 +/- 1.2, p <0.001). Increased serum creatinine levels at age 5 years were associated with later daytime and nighttime continence (mean +/- SD 6.0 +/- 3.2 and 5.5 +/- 2.6 years, respectively, vs 4.1 +/- 2.3 and 3.7 +/- 1.4 years, respectively, in patients with normal serum creatinine, p Conclusions: Patients with posterior urethral valves achieve daytime and nighttime urinary continence significantly later than their healthy peers. Prenatal or neonatal diagnosis and high serum creatinine are associated with later attainment of continence.Peer reviewe