Neck Muscle Function and Adolescent Headache

Muscular function of the neck region may be of importance for the etiology of headache, especially of tension-type headache. However, very few data exist on the association of neck muscle function with different types of headache in adolescents. The main aim of the study was to examine the association of neck muscle function with adolescent headache. The associations between leisure time activities, endurance strength of the upper extremities (UE endurance) and mobility of the neck-shoulder region and adolescent headache were studied. In addition, the associations of force production, EMG/force ratio, co-activation and fatigue characteristics, and cross-sectional area (CSA) of neck muscles with adolescent headache were studied. The study is part of a population-based cohort study of 12-year-old children with and without headache. The study had five phases (years 1998-2003). At the age of 13 years, a sample of 183 adolescents (183/311) participated in endurance strength and mobility measurements of the neck-shoulder region. In addition, the type and level of physical and other leisure activity were elicited with open and structured questions. At the age of 17 years, a random sample of 89 adolescents (89/202) participated in force and EMG measurements of the neck-shoulder muscles. In addition, at the age of 17 years, a sample of 65 adolescents (65/89) participated in CSA measurements of the neck muscles. At the age of 13 years, intensive participation in overall sports activity was associated with migraine. Frequent computer use was associated both with migraine and tension-type headache. The type of sports or other leisure activity classified them on the basis of body loading was not associated with headache type. In girls, low UE endurance of both sides, and low cervical rotation of the dominant side, were associated with tension-type headache, and low UE endurance of non-dominant side with migraine. In boys, no associations occurred between UE endurance and mobility variables and headache types. At the age of 17 years, in girls, high EMG/force ratios between the EMG of the left agonist sternocleidomastoid muscle (SCM) and maximal neck flexion and neck rotation force to the right side as well as high co-activation of right antagonist cervical erector spinae (CES) muscles during maximal neck flexion force were associated with migraine-type headache. In girls, neck force production was not associated with headache types but low left shoulder flexion force was associated with tension-type headache. In boys, no associations were found between EMG and force variables and headache. Increased SCM muscles fatigue of both sides was associated with tension-type headache. In boys, the small CSA of the right SCM muscle and, in girls, of combined right SCM and scalenus muscles was associated with tension-type headache. Similarly, in boys, the large CSA of the right SCM muscle, of the combined right SCM and scalenus muscles, of the left semispinalis capitis muscle, of the combined left semispinalis and splenius muscles was associated with migraine. No other differences in the CSA of neck flexion or extension muscles were found. Differences in the neuromucular function of the neck-shoulder muscles were associated with adolescent headache, especially in girls. Differences in the cross-sectional area of unilateral neck muscles were associated with headache, especially in boys. Differences in the neuromuscular function and in the cross-sectional area of the neck muscles also occurred between different types of headache. It remains to be established whether the findings are primary or secondary to adolescent migraine and tension headache. Keywords: adolescent, cross-sectional area, electromyography, endurance strength, fatigue, force, headache, leisure time activity, migraine, mobility, neck muscles, tension-type headacheNiskalihasten toiminta nuorten päänsäryssä Niskalihasten toimintahäiriöillä voi olla merkitystä päänsäryn aiheuttajana, erityisesti tensiotyyppisessä päänsäryssä. Tutkittua tietoa niskalihasten toiminnan ja päänsäryn yhteydestä lapsilla ja nuorilla on olemassa erittäin vähän. Tutkimuksen päätarkoituksena oli selvittää niskalihasten toimintahäiriöiden yhteyttä nuoren päänsärkyyn. Tutkimuksessa tutkittiin vapaa-ajan harrastusten, niskahartiaseudun kestävyysvoiman ja liikkuvuuden sekä niskalihasten voiman, EMG/voimasuhteen, yhtäaikaisen aktivoitumisen, väsyvyyden ja poikkipinta-alan yhteyttä nuoren päänsärkyyn. Tämä tutkimus on osa väestöpohjaista 12-vuotiaiden päänsärkyisten ja päänsäryttömien lasten kohortti-tutkimusta. Tutkimus koostuu viidestä eri vaiheesta (vuodet 1998-2003). 13-vuotiaina 183 nuorta (183/311) osallistui niskahartiasedun kestävyyden ja liikkuvuuden mittauksiin. Lisäksi selvitettiin liikunnan ja muun vapaa-ajan harrastuksen sisältöä ja määrä avoimilla ja suljetuilla kysymyksillä. 17-vuotiaina 89 nuorta (89/202) osallistui niskalihasten voima- ja EMG-mittauksiin. Lisäksi 17-vuotiaina 65 nuorta (65/89) osallistui niskalihasten poikkipinta-alamittauksiin. Nuorten ollessa 13-vuotiaita, liikunnan harrastamisen intensiivisyys oli yhteydessä migreeniin ja tietokoneen runsas käyttö sekä migreeniin että tensiotyyppiseen päänsärkyyn. Liikunnan tai muulla vapaa-ajan harrastuksella, luokiteltaessa harrastukset kehon eri osien kuormittavuden suhteen, ei ollut yhteyttä päänsärkyyn. Tytöillä alhainen sekä hallitsevan että ei-hallitsevan puolen hartiaseudun lihaskestävyys ja alentunut niskan kiertoliike hallitsevalle puolelle olivat yhteydessä tensiotyyppiseen päänsärkyyn ja ei-hallitsevan puolen alhainen hartiaseudun lihaskestävyys migreeniin. Pojilla ei esiintynyt eroja lihaskestävyyden ja liikkuvuuden suhteen eri päänsärkyryhmissä. Nuorten ollessa 17-vuotiaita, tytöillä korkea EMG/voimasuhde vasemman puolen sternocleidomastoideus lihaksen (SCM, agonisti) EMG aktiivisuuden ja vastaavan niskalihasten maksimaalisen fleksiovoiman ja oikealle suunnatun maksimaalisen kiertovoiman välillä oli yhteydessä migreeniin. Lisäksi korkea oikeanpuolen niskan ojentajalihasten (CES, antagonisti) yhtäaikainen aktivoituminen maksimaalisen fleksio-voimantuoton aikana olivat yhteydessä migreeniin. Tytöillä niskalihasten voima ei ollut yhteydessä päänsärkytyyppiin, mutta alhainen olkanivelen fleksiovoima oli yhteydessä tensiotyyppiseen päänsärkyyn. Pojilla ei esiintynyt eroja niskalihasten voiman ja EMG-aktiivisuuden suhteen eri päänsärkyryhmissä. Sekä oikean että vasemman puolen SCM lihasten lisääntynyt väsyvyys oli yhteydessä tensiotyyppiseen päänsärkyyn. Pojilla oikean SCM lihaksen pieni poikkipinta-ala ja tytöillä oikean puolen yhdistetyn SCM ja scalenus lihaksen pieni poikkipinta-ala olivat yhteydessä tensiotyyppiseen päänsärkyyn. Vastaavasti pojilla suuret oikean puolen SCM lihaksen, oikean puolen yhdistetyn SCM ja scalenus lihaksen, vasemman puolen semispinalis capitis lihaksen, yhdistetyn semispinalis capitis ja splenius lihaksen poikkipinta-alat olivat yhteydessä migreeniin. Muissa niskalihasten poikkipinta-aloissa ei esiintynyt eroja ryhmien välillä tytöillä ja pojilla. Niska- ja hartialihasten toiminnan poikkeavuudet olivat yhteydessä päänsärkyyn, erityisesti tytöillä. Toispuoliset poikkeavuudet niskalihasten poikkipinta-alassa olivat yhteydessä päänsärkyyn, erityisesti pojilla. Niskalihasten toiminnassa ja poikkipinta-alassa esiintyi myös eroja päänsärkyryhmien välillä. Se, ovatko löydökset nuorilla päänsärkyä aiheuttavia tekijöitä vai seurausta päänsärystä jää selvitettäväksi.Siirretty Doriast

Combining biological therapies in patients with inflammatory bowel disease : a Finnish multi-centre study

Background and aims Therapy with two concomitant biologicals targeting different inflammatory pathways has emerged as a new therapy option for treatment refractory inflammatory bowel disease (IBD). Data on the efficacy and safety of dual biological therapy (DBT) are scarce and are investigated in this study. Materials and methods Data on all patients treated with a combination of two biologicals in four Finnish tertiary centres were collected and analysed. Remission was assessed by a physician on the basis of biomarkers, endoscopic evaluation and alleviation of symptoms. Results A total of 16 patients with 22 trials of DBT were included. Fifteen patients had Crohn's disease. The most common combination of DBT was adalimumab (ADA) and ustekinumab (USTE; 36%) with median follow-up of nine months (range 2-31). Altogether seven (32%) patients were in remission at the end of follow-up and in two trials response to DBT was assessed to be partial with the relief of patient symptoms. In a total of four trials DBT reduced the need for corticosteroids. The majority of patients achieving a response to DBT were treated with the combination of ADA and USTE (56%). At the end of follow-up all nine (41%) patients responding to DBT continued treatment. Infection complications occurred in three patients (19%). Conclusion DBT is a promising alternative treatment for refractory IBD, and half of our patients benefitted from it. More data on the efficacy and safety of DBT are needed especially in long-term follow up.Peer reviewe

Long-term outcomes of patients with acute severe ulcerative colitis treated with cyclosporine rescue therapy

BACKGROUND AND AIMS: The early outcomes of ulcerative colitis (UC) after rescue therapy with cyclosporine A (CyA) are well known. Published data on the safety of this treatment in perioperative use and data on the long-term prognosis are scarce and are investigated here. METHODS: All UC patients treated with CyA in Tampere University Hospital between 2009 and 2018 were reviewed from patient records. RESULTS: A total of 182 patients were included with the median follow-up of 3.8 (range 0-13) years. Of all patients, 139 (76%) responded to CyA. A quarter of the responders achieved long-term remission and used thiopurines as maintenance therapy at the end of follow-up. Altogether 83 (46%) needed further enhancement of treatment with corticosteroids (Cs) and 57 (31%) with biologicals or small molecules. Of the nonresponders 27 (55%) were treated surgically within admission to index flare. Infliximab was used as a third-line rescue therapy for 16 patients of whom four benefitted. The overall colectomy rate in this series was 45%. When compared to Cs alone CyA did not increase the risk for severe postoperative complications in patients treated for severe treatment-refractory UC. CONCLUSION: In conclusion, despite the good initial response to CyA, a large proportion of patients relapsed during long-term follow-up and the colectomy rates remain high. Other therapy attempts after failure of CyA merely postpone surgery in many. We therefore recommend informing patients about the possibility of surgery prior to the initiation of rescue therapy.publishedVersionPeer reviewe

Combining biological therapies in patients with inflammatory bowel disease: a Finnish multi-centre study

Background and aims: Therapy with two concomitant biologicals targeting different inflammatory pathways has emerged as a new therapy option for treatment refractory inflammatory bowel disease (IBD). Data on the efficacy and safety of dual biological therapy (DBT) are scarce and are investigated in this study.Materials and methods: Data on all patients treated with a combination of two biologicals in four Finnish tertiary centres were collected and analysed. Remission was assessed by a physician on the basis of biomarkers, endoscopic evaluation and alleviation of symptoms.Results: A total of 16 patients with 22 trials of DBT were included. Fifteen patients had Crohn's disease. The most common combination of DBT was adalimumab (ADA) and ustekinumab (USTE; 36%) with median follow-up of nine months (range 2-31). Altogether seven (32%) patients were in remission at the end of follow-up and in two trials response to DBT was assessed to be partial with the relief of patient symptoms. In a total of four trials DBT reduced the need for corticosteroids. The majority of patients achieving a response to DBT were treated with the combination of ADA and USTE (56%). At the end of follow-up all nine (41%) patients responding to DBT continued treatment. Infection complications occurred in three patients (19%).Conclusion: DBT is a promising alternative treatment for refractory IBD, and half of our patients benefitted from it. More data on the efficacy and safety of DBT are needed especially in long-term follow up.</p

Effects of a home-based, exergaming intervention on physical function and pain after total knee replacement in older adults : a randomised controlled trial

Objectives To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods In this non-blinded randomised controlled trial, 52 individuals aged 60-75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by -1.9 s (95% CI, -2.9 to -1.0), while it changed by -0.6 s (95% CI -1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number NCT03717727.publishedVersionPeer reviewe

Genome sequencing and population genomic analyses provide insights into the adaptive landscape of silver birch

Silver birch (Betula pendula) is a pioneer boreal tree that can be induced to flower within 1 year. Its rapid life cycle, small (440-Mb) genome, and advanced germplasm resources make birch an attractive model for forest biotechnology. We assembled and chromosomally anchored the nuclear genome of an inbred B. pendula individual. Gene duplicates from the paleohexaploid event were enriched for transcriptional regulation, whereas tandem duplicates were overrepresented by environmental responses. Population resequencing of 80 individuals showed effective population size crashes at major points of climatic upheaval. Selective sweeps were enriched among polyploid duplicates encoding key developmental and physiological triggering functions, suggesting that local adaptation has tuned the timing of and cross-talk between fundamental plant processes. Variation around the tightly-linked light response genes PHYC and FRS10 correlated with latitude and longitude and temperature, and with precipitation for PHYC. Similar associations characterized the growth-promoting cytokinin response regulator ARR1, and the wood development genes KAK and MED5A.Peer reviewe

Author Correction: Genome sequencing and population genomic analyses provide insights into the adaptive landscape of silver birch.

In the version of this article initially published, there was a mistake in the calculation of the nucleotide mutation rate per site per generation: 1 × 10−9 mutations per site per generation was used, whereas 9.5 × 10−9 was correct. This error affects the interpretation of population-size changes over time and their possible correspondence with known geological events, as shown in the original Fig. 4 and supporting discussion in the text, as well as details in the Supplementary Note. Neither the data themselves nor any other results are affected. Figure 4 has been revised accordingly. Images of the original and corrected figure panels are shown in the correction notice

Prospective study of pain and psychological symptoms of first-year university students

Background: Even if pain and psychological symptoms experienced by university students are common, the prognosis of these symptoms is unknown. Objective: To examine the incidence and the outcome of frequent musculoskeletal and psychological symptoms in a 4-year follow-up of first-year university students. Methods: In 2008, a national random sample (N=2750) of Finnish university students completed a questionnaire concerning pain and psychological symptoms. Of the 416 first-year students, 123 responded to the same questionnaire also in their fourth study year in 2012. Results: Of the first-year university students with frequent pain or psychological symptoms, &shy;one half (47% - 65%) reported frequent symptoms also four years later. Almost all (78% &ndash; 95%) of the symptom-free first-year students were symptom-free also in their fourth study year. Conclusion: Our findings indicate that pain and psychological symptoms in university students are rather persistent during the first four study years. On the other hand, as half of those with frequent symptoms become symptomless and as the prognosis of symptom-free students is favourable, there is still need for further cohort studies on this issue

Concurrent validity and repeatability of inertial sensor gait analysis system for the measurement of gait parameters of young healthy adults

Purpose: To examine the concurrent validity and test–retest repeatability of the RehaWatch® system for the assessment of spatiotemporal parameters of gait. Methods: Spatiotemporal gait parameters were recorded using the RehaWatch® and GAITRite® systems among 17 healthy young adults (mean age = 21.5 years, SD = 1.9). Concurrent validity was assessed by comparing data obtained using both gait measurement systems, and repeatability of the RehaWatch® measurements was assessed between the six measurement trials. Results: The level of agreement between both measurement systems was strong as for the velocity, cadence, and double support time of the left side (r = 0.73–0.95) and moderate for double support time of the right side, and swing and stance time of both sides (r = 0.46–0.69). The hierarchical linear mixed model showed mostly good repeatability for gait parameters between the six trials. Despite some statistically significant mean differences over the trials, such as in cadence and swing time of left side, the differences were minor had no clinical significance. Conclusions: The RehaWatch® system has acceptable validity and test–retest repeatability in most of the spatiotemporal gait parameters in healthy young adults. The RehaWatch® system could be recommended to be used consistently and carefully for both clinical and research purposes

Liikuntainterventio parantaa syöpää sairastavien lihasvoimaa ja vähentää uupuneisuutta

Syövän hoito vaikuttaa laaja-alaisesti sairastuneen liikkumis- ja toimintakykyyn sekä voi heikentää hänen fyysistä aktiivisuuttaan. Turun yliopistollisessa keskussairaalassa pilotoitiin progressiivinen liikuntainterventio syöpää sairastavien solunsalpaajahoidon yhteydessä