Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background: Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.Methods: This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.Results: 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).Conclusions: FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.</p

A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)

<p>Abstract</p> <p>Background</p> <p>Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.</p> <p>Methods</p> <p>Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.</p> <p>Results</p> <p>18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger's graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.</p> <p>Conclusion</p> <p>LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.</p

Factors, complications and health-related quality of life associated with diabetes mellitus developed after midlife in men

Abstract Type 2 diabetes is increasing overall in the world and is mostly associated with Western lifestyle including replete, unhealthy diet, sedentary life style and growing obesity. In the future the highest prevalence will be seen among older people due to longer life expectancy and changes in demography. Because diabetes is associated with increased morbidity, especially from cardiovascular causes, and a shortened life expectancy, an important aspect in the older population is the impact of diabetes on health related quality of life (HRQoL) and development of disability. To measure HRQoL we have many valid instruments, one of them the widely used RAND-36 survey. The 2-hour glucose value is important in screening subjects at high risk for diabetes, but it is time consuming and costly. Recently, 1-hour post load glucose has aroused interest in the prediction of diabetes. Few studies have focused on the effect of the age of onset of diabetes and how it effects on the HRQoL at an older age. The aim of this study was to investigate the risk factors for future diabetes in men healthy in midlife; the interest was especially focused on 1-hour post load glucose. The other objective was to estimate the HRQoL in men who develop diabetes at an old age. The present prospective study is based on the Helsinki Businessmen Study originally consisting of 3.490 men, born in 1919–1934 and followed since the 1960´s. All the men had socioeconomically similar status and belonged to the highest social group. The extensive baseline examinations were conducted in 1974, when the men were in midlife, mean age 48. At that time the men´s health, medication and cardiovascular risk factors were observed and self-related health (SRH) was rated on a five-step scale. The men who were healthy without medications were included in the follow-up group. The men were later investigated with postal questionnaires (1985/86, 2000, 2002/03, 2007). In 2000, at mean age of 73, the HRQoL of the survivors was examined using the RAND-36 instrument and was replicated in 2002/03, 2005 and 2007. Development of diabetes was evaluated using the National Drug Reimbursement register and self-reported diabetes in questionnaires. Baseline 1-hour post-load blood glucose and weight gain from the age of 25 to midlife predicted future diabetes, and especially a combination of 1-hour glucose >8.9 mmol/L and body mass index (BMI) of &#8805;30 was associated with a 10.1-fold increase of diabetes risk independently of cardiovascular risk factors. Men with late-onset of diabetes (age >75) tented to be healthier in midlife. Diabetes did not affect the HRQoL until after diabetes onset. According to the evaluation in 2000, three RAND-36 scales, i.e. physical functioning, general health and social functioning, worsened already after 0–4 years from diabetes onset but did not deteriorate thereafter. There was no consistent impact on mental health. In conclusion, this study demonstrates that in men, who develop diabetes later in old age, cardiovascular risk factors in midlife and elevated 1-hour post-load glucose and weight gain up to midlife are important predictors for future diabetes. Developing diabetes exerts clear effects on HRQoL, measured with RAND-36 very early after diagnosis, but affects only some of the domains.Tiivistelmä Tyypin 2 diabetes on lisääntymässä maailmanlaajuisesti ja on suurelta osin yhteydessä länsimaisen elämäntyylin yleistymiseen. Keskeisimpinä tekijöinä ovat muuttunut, yltäkylläinen ruokavalio, vähentynyt fyysinen aktiivisuus ja niiden myötä lihavuuden lisääntyminen. Diabeteksen lisääntyminen näyttäisi olevan suurinta yli 65-vuotiaiden keskuudessa. Tähän vaikuttavat mm. eliniän pidentyminen ja väestörakenteen muutokset. Diabetesta sairastavien riski sairastua ja kuolla sydän- ja verisuonisairauksien komplikaatioihin on suurempi kuin ei-diabeetikoilla ja sairauksien myötä toimintakyky sekä elämänlaatu heikkenevät. Henkilön oma arvio hyvinvoinnista on tärkeä mittari. Elämänlaadun luotettava mittaaminen on tullut mahdolliseksi testattujen kysymyssarjojen myötä. Yksi laajasti käytetty mittari on RAND-36. Diabetesriskissä olevien henkilöiden löytämiseksi on käytetty 2-tunnin glukoosirasitustestiä, joka on aikaa vievä. Viimeaikoina onkin herännyt kiinnostus glukoosirasituksen jälkeistä yhden tunnin sokeriarvoa kohtaan. Useimmat tyypin 2 diabetekseen liittyvät tutkimukset ovat keskittyneet työikäiseen väestöön, minkä vuoksi tutkimuksia vanhemmalla iällä puhjenneesta diabeteksesta ja sen vaikutuksesta elämänlaatuun on vähemmän. Tämän tutkimuksen tarkoituksena oli selvittää keski-iän riskitekijöitä, jotka ennustavat tulevaa tyypin 2 diabetesta myöhemmällä iällä. Yhtenä tutkimuskohteena oli yhden tunnin glukoosirasituksen jälkeinen sokeriarvo. Myöhemmällä iällä puhjenneen diabeteksen merkitystä elämänlatuun kartoitettiin RAND-36-mittarilla. Tutkimusaineistona oli ns. Helsingin Johtajatutkimuksen mieskohortti, jota on seurattu 1960-luvulta alkaen. Kaikki miehet (n=3.490) olivat alkuaan terveitä, vuosina 1919–1934 syntyneitä miehiä, jotka kuuluivat ylimpään sosiaaliryhmään. Heidän terveydentilaansa on kartoitettu nykypäiviin saakka. Laajempi perustutkimus tehtiin vuonna 1974, jolloin miehet olivat keski-iässä (48 v). Seurantaan valittiin terveet henkilöt, joilla ei ollut säännöllisiä lääkityksiä. Tällöin kartoitettiin sydän- ja verisuonisairauksien riskitekijöitä, mitattiin glukoosirasituksen jälkeinen yhden tunnin sokeriarvo ja selviteltiin elämäntapoja, minkä lisäksi sen hetkistä itse koettua hyvinvointia mitattiin 5-portaisella asteikolla. Postitse lähetettyjä kyselytutkimuksia on tehty tietyin väliajoin ja aineiston tiedot tähän tutkimukseen on kerätty 31.12.2007 mennessä. Vuonna 2000 kyselytutkimukseen liitettiin elämänlaatumittarina RAND-36-mittarin suomalainen versio. Diabeteksen puhkeamista on seurattu Kelan lääkekorvausrekisteristä sekä itse ilmoitettuna postikyselyiden kautta. Tässä keski-iässä terveessä mieskohortissa tulevan diabeteksen kannalta merkittävimmät ennusteelliset tekijät olivat painon nousu 25-vuoden iästä keski-ikään sekä keski-iässä mitattu glukoosirasituksen jälkeinen yhden tunnin sokeriarvo. Etenkin yhden tunnin sokeriarvo >8.9 mmol/L ja BMI &#8805;30 nostivat tulevan diabeteksen riskin 10-kertaiseksi. Näillä tekijöillä oli myös vahva yhteys sydän- ja verisuonisairauksien aiheuttamaan kuolleisuuteen. Glukoosirasituksen jälkeisellä yhden tunnin sokeriarvolla näyttäisi olevan merkitystä arvioitaessa tyypin 2 diabetesriskiä tulevaisuudessa, katkaisupisteenä plasman &#8805;7.8 mmol/L. Elämänlaatua diabetes näytti heikentävän pian diagnoosin jälkeen (0–4 vuotta diagnoosista), mutta sen jälkeen elämänlaatu ei huonontunut oleellisesti. RAND-36 mittarilla mitattuna elämänlaatu heikkeni merkittävästi diabeetikoilla ei-diabeetikoihin verrattuna fyysisen toimintakyvyn, yleisen elämänlaadun ja sosiaalisten toimintojen osa-alueilla, mutta mielenterveyteen diabetes ei näyttänyt vaikuttavan

Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain

Abstract Objectives: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results: The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01–1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92–1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain

No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study

The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used