Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke : A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke. Data Sources: A systematic literature search was conducted in 6 databases from January 2000 to May 2018. Study Selection: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (0) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies. Data Extraction: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable. Data Synthesis: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low. Conclusions: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke. (C) 2018 by the American Congress of Rehabilitation MedicinePeer reviewe

Proliferative verrucous leukoplakia and its tumor markers: Systematic review and meta-analysis

Background: The aim was to update information on oral proliferative verrucous leukoplakia (PVL), a disease of verrucous‐like lesions with high risk of malignancy, and its biomarkers.Methods: A systematic search of literature on PVL and its biomarkers showed 22 biomarkers that were investigated in 19 papers. A meta‐analysis was possible for human papillomavirus (HPV), aneuploidy, Ki‐67, and p53.Results: Aneuploidy was found consistently (I2 = 0%, P = 0.61) in 92% (95% CI 80%‐99%) of the PVL cases. P53 positivity prevalence was 27% (95% CI 15%‐40%) in two available studies (I2 = 0%, P = 0.64). With HPV and Ki‐67, the most outlying studies needed to be removed and after that the pooled HPV positivity prevalence (I2 = 24%, P = 0.27) was 5% (95% CI 0%‐14%) and for Ki‐67 (I2 = 9%, P = 0.33) 14% (95% CI 6%‐26%).Conclusions: With the evidence of the current literature, aneuploidy could value as a biomarker of PVL but should be further validated.</p

Low trypsinogen-1 expression in pediatric ulcerative colitis patients who undergo surgery

Peer reviewe

Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland

publishedVersionPeer reviewe

Performance of the Check-Direct ESBL Screen for BD MAXTM for detection of asymptomatic faecal carriage of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae

ObjectivesAccurte diagnostic methods are crucial for the detection of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). Besides culture-based gold-standard methods, new molecular gene detection tests are reaching the market. The aim of this study was to investigate the performance of the direct quantitative PCR (qPCR)-based methods Check-Direct ESBL and CPE Screen for BD MAXTM in relation to traditional culture-based methods for detection of ESBL-E faecal carriage.MethodsFaecal samples were collected from healthy adult volunteers. Samples were cultured on chromogenic ESBL agar plates and were screened for ESBL-producing Escherichia coli and Klebsiella pneumoniae. Confirmed ESBL- and AmpC-producing isolates were further analysed using whole-genome sequencing. In addition, faecal samples were analysed using Check-Direct ESBL and CPE Screen for BD MAXTM and the results were compared with the gold-standard culture-based method.ResultsOf 176 faecal samples examined, 11 (6.3%) grew ESBL-producing E. coli or K. pneumoniae isolates. Among 173 analysed samples, Check-Direct ESBL Screen for BD MAXTM detected 22 (12.7%) ESBL-positive samples. No carbapenemase-producing isolates were detected. Two culture-positive samples remained negative with Check-Direct ESBL Screen for BD MAXTM. Culture-negative but qPCR-positive discrepancy was observed in 12 samples (6.9%). Altogether, concordant results were obtained for 158 samples (91.3%; 9 positive and 149 negative).ConclusionCheck-Direct ESBL Screen for BD MAXTM is a fast screening method for ESBL carriage. However, several discrepant results were observed, which hinders interpretation. More clinical samples should be tested in combination with culture to evaluate the true benefits of this method.</div

Cisplatin overcomes radiotherapy resistance in OCT4-expressing head and neck squamous cell carcinoma

Objectives: Cisplatin is combined with radiotherapy for advanced head and neck squamous cell carcinoma (HNSCC). While providing a beneficial effect on survival, it also causes side effects and thus is an important target when considering treatment de-escalation. Currently, there are no biomarkers to predict its patientselective therapeutic utility. In this study, we examined the role of the stem cell factor OCT4 as a potential biomarker to help clinicians stratify HNSCC patients between radiotherapy and chemoradiotherapy. Materials and methods: OCT4 immunohistochemical staining of a population-validated tissue microarray (PV-TMA) (n = 166) representative of a standard HNSCC patients was carried out, and 5-year survival was analyzed. The results were validated using ex vivo drug sensitivity analysis of HNSCC tumor samples, and further crossvalidated in independent oropharyngeal (n = 118), nasopharyngeal (n = 170), and vulvar carcinoma (n = 95) clinical datasets. In vitro, genetically modified, patient-derived HNSCC cells were used. Results: OCT4 expression in HNSCC tumors was associated with radioresistance. However, combination therapy with cisplatin was found to overcome this radioresistance in OCT4-expressing HNSCC tumors. The results were validated by using several independent patient cohorts. Furthermore, CRISPRa-based OCT4 overexpression in the HNSCC cell line resulted in apoptosis resistance, and cisplatin was found to downregulate OCT4 protein expression in vitro. Ex vivo drug sensitivity analysis of HNSCC tumors confirmed the association between OCT4 expression and cisplatin sensitivity. Conclusion: This study introduces OCT4 immunohistochemistry as a simple and cost-effective diagnostic approach for clinical practice to identify HNSCC patients benefitting from radiosensitization by cisplatin using either full or reduced dosing.Peer reviewe

Faecalibacterium prausnitzii Treatment Improves Hepatic Health and Reduces Adipose Tissue Inflammation in High-fat Fed Mice

Faecalibacterium prausnitzii is considered as one of the most important bacterial indicators of a healthy gut. We studied the effects of oral F. prausnitzii treatment on high-fat fed mice. Compared to the high-fat control mice, F. prausnitzii-treated mice had lower hepatic fat content, aspartate aminotransferase and alanine aminotransferase, and increased fatty acid oxidation and adiponectin signaling in liver. Hepatic lipidomic analyses revealed decreases in several species of triacylglycerols, phospholipids and cholesteryl esters. Adiponectin expression was increased in the visceral adipose tissue, and the subcutaneous and visceral adipose tissues were more insulin sensitive and less inflamed in F. prausnitzii-treated mice. Further, F. prausnitzii treatment increased muscle mass that may be linked to enhanced mitochondrial respiration, modified gut microbiota composition and improved intestinal integrity. Our findings show that F. prausnitzii treatment improves hepatic health, and decreases adipose tissue inflammation in mice and warrant the need for further studies to discover its therapeutic potential.</p

Oulujoen–Iijoen vesienhoitoalueen vesienhoitosuunnitelma vuosille 2022–2027 : Osa 1: Vesienhoitoaluekohtaiset tiedot

Vesienhoitosuunnitelmaan on koottu tiedot vesien tilasta sekä vesien tilan parantamiseksi ja ylläpitämiseksi tarvittavista toimenpiteistä Oulujoen–Iijoen vesienhoitoalueella. Luokiteltujen virtavesien yhteen lasketusta pituudesta 64 % ja järvien pinta-alasta 94 % vastaa erinomaisen tai hyvän ekologisen tilan kriteerejä. Rannikkovesien tilaluokat ovat laajalti heikentyneet edelliseen luokitteluun verrattuna. Pinta-alasta alle viidennes on hyvässä ekologisessa tilassa. Pintavesien ekologista tilaa heikentää yleisesti rehevöityminen ja liettyminen. Kuormitusta syntyy maan kuivauksesta ja muokkaamisesta, mutta myös pistemäisellä kuormituksella on vaikutusta. Muita paineita ovat hydrologiset ja morfologiset muutokset, rannikon tuntumassa happamoittavien aineiden kuormitus ja varsinkin Kuusamon alueella vesirutto. Yksikään pintavesimuodostumista ei ole kemialliselta tilaltaan hyvä. Tämä johtuu kaikkialla esiintyvien bromattujen difenyylieettereiden ympäristölaatunormin ylityksestä, Oulujoen vesistössä ja sen eteläpuoleisissa vesistöissä myös maaperään vuosikymmenten aikana kertyneestä elohopeasta. Kaikkien pohjavesimuodostumien kemiallinen ja määrällinen tila on hyvä. Vesienhoitoalueella on tunnistettu 35 riski-pohjavesialuetta ja 44 selvityskohteesta tarvitaan lisää tietoa. Rehevyyteen liittyviä parantamistarpeita on koko vesienhoitoalueella painottuen kuitenkin sen eteläisiin ja läntisiin osiin. Vesienhoitosuunnitelmassa esitettävillä toimenpiteillä vähennetään rehevöitymisen lisäksi vesiympäristölle vaarallisten ja haitallisten aineiden esiintymistä, happamuuskuormitusta sekä vesistöjen rakenteessa ja hydrologiassa tapahtuneiden muutosten vaikutuksia. Tarkemmat, vesistökohtaiset tiedot toimenpiteistä ja niiden kohdentumisesta löytyvät vesienhoitoalueen toimenpideohjelmasta. Esitettyjen toimenpiteiden kokonaiskustannukset ovat noin 160 miljoonaa euroa. Tästä noin 40 miljoonaa euroa on muun lainsäädännön perusteella toteutettavien ja 120 miljoonaa euroa vesienhoidon täydentävien toimenpiteiden osuus. Arviolta 25 järveä, 29 jokea ja yksi rannikkovesimuodostuma eivät toimenpiteistä huolimatta tule saavuttamaan hyvää ekologista tilaa vielä vuonna 2027. Vesien tila on kuitenkin laajalti kohentumassa vesienhoitotoimenpiteiden toteutuksen myötä

Changing epidemiology of methicillin-resistant Staphylococcus aureus in a low endemicity area- new challenges for MRSA control

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) has increased sharply in Hospital District of Southwest Finland (HD). To understand reasons behind this, a retrospective, population-based study covering 10 years was conducted. All new 983 MRSA cases in HD from January 2007 to December 2016 were analysed. Several data sources were used to gather background information on the cases. MRSA cases were classified as healthcare-associated (HA-MRSA), community-associated (CA-MRSA), and livestock contact was determined (livestock-associated MRSA, LA-MRSA). Spa typing was performed to all available strains. The incidence of MRSA doubled from 12.4 to 24.9 cases/100000 persons/year. The proportion of clinical infections increased from 25 to 32% in the 5-year periods, respectively, (p </p

Elimination of Epidemic Methicillin-Resistant Staphylococcus aureus from a University Hospital and District Institutions, Finland

From August 1991 to October 1992, two successive outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) occurred at a hospital in Finland. During and after these outbreaks, MRSA was diagnosed in 202 persons in our medical district; >100 cases involved epidemic MRSA. When control policies failed to stop the epidemic, more aggressive measures were taken, including continuous staff education, contact isolation for MRSA-positive patients, systematic screening for persons exposed to MRSA, cohort nursing of MRSA-positive and MRSA-exposed patients in epidemic situations, and perception of the 30 medical institutions in that district as one epidemiologic entity brought under surveillance and control of the infection control team of Turku University Hospital. Two major epidemic strains, as well as eight additional strains, were eliminated; we were also able to prevent nosocomial spread of other MRSA strains. Our data show that controlling MRSA is possible if strict measures are taken before the organism becomes endemic. Similar control policies may be successful for dealing with new strains of multiresistant bacteria, such as vancomycin-resistant strains of S. aureus