Recovery Potential of Spinal Meningioma Patients With Preoperative Loss of Walking Ability Following Surgery - A Retrospective Single-Center Study

Objective: Spinal meningiomas are neurosurgical rarities that manifest with progressive paraor tetraparesis. The effect of timing of surgery on the recovery after the loss of walking ability is poorly known. We studied the effect of timing of surgery on restoring walking ability in surgically-treated spinal meningioma patients. Methods: Using electronic health records, we retrospectively identified >= 18-year-old patients operated on during 2010-2020. The patients were followed until 30th September 2020, death or emigration. Results: We identified 108 patients (81% women) with operated spinal meningiomas. The mean age of the patients was 64 years (range, 18-94 years). A gross total resection was achieved in 101 (94%), and 21 patients (19%) suffered from perioperative complications. Of the 108 patients operated on, 49 (45%) could not walk without assistance prior to surgery. At the time of first postoperative visit (mean, 3.1 months; range, 1.3-13.1 months), 14 out of 24 patients (58%) operated on within 29 days and 8 out of 20 patients (40%) operated on later than 29 days since the loss of walking ability without assistance, were able to walk without assistance. Also, 3 out of 5 paraplegic patients who underwent surgery later than 29 days after they lost the walking ability, were able to at least walk with assistance at first postoperative visit. Conclusion: Early surgical treatment following the loss of walking ability restores walking ability in a substantial number of patients. However, even late surgery may restore walking ability.Peer reviewe

Objectively measured preoperative physical activity and sedentary behaviour among Finnish patients scheduled for elective cardiac procedures : baseline results from randomized controlled trial

Background: We investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults. Methods: Cardiac patients (n=139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5-2.9 METs) and moderate-to-vigorous (MVPA, >= 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017. Results: Cardiac patients had fewer daily steps than the FinFit population (p= 0.01), and less SB accumulating from 10 min bouts (p< 0.001) than the FinFit population. Conclusions: We found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively.Peer reviewe

Physical activity and sedentary behaviour in secondary prevention of coronary artery disease: A review

Comprehensive management of coronary artery disease (CAD) includes physical exercise as a part of daily lifestyle therapy. Still CAD patients generally have low physical activity (PA) and high sedentary behaviour (SB). This review summarizes the effect of exercise training and habitual PA and SB on physical fitness and quality of life (QoL) as well as on rehospitalizations and mortality in patients with stable CAD, recent acute coronary syndrome (ACS) or recent revascularization. A literature review of the influence of exercise, and PA and SB profiles in secondary prevention of CAD was performed using PubMed. All articles published between January 2001 and April 2019, meeting the inclusion criteria were considered. A total of 25 cross-sectional or prospective studies or randomized controlled trials (RCT) were included to this review. Exercise training was found to improve maximal oxygen consumption, QoL, and to reduce rehospitalizations and mortality among patients with established CAD. Remote PA interventions have not been as effective as the supervised exercise sessions in reducing the clinical endpoints. High SB, especially when combined to low PA, is associated with poor cardiorespiratory fitness and worse long-term prognosis among patients with ACS. In conclusion, exercise training and high PA are beneficial for patients with stable CAD, recent ACS or recent revascularization. High SB is associated with poor cardiopulmonary fitness and increased mortality in ACS patients. Novel tools using online applications and smart devices are promising means to offer remote guidance for PA among patients unable to participate in regular exercise sessions

Declining Fitness Levels are a Challenge to Well-Being in Finland – effective actions to increase physical activity and reverse the downward spiral of fitness

The physical functional capacity of Finns has been declining for decades: • The number of young men entering military service with poor physical fitness has increased eightfold • The number of men with poor muscle fitness has increased manifold • The average weight of new recruits has increased by 8 kg • The results of the MOVE! measurements of schoolchildren show the same alarming trend also in schoolchildren. As a result of the prolonged negative trend described above, the physical fitness of Finns of working age will continue to deteriorate significantly also in the coming decades. By 2040, according to a very conservative forecast, only very few people aged 50 or over in Finland will be in good physical fitness. This vicious cycle will lead to an increasing incidence of non-communicable diseases (such as type 2 diabetes, depression, cardiovascular diseases, musculoskeletal diseases, etc.). Being ill leads to increased sickness absences, earlier disability, and lower labour productivity. Unless this negative trend can be reversed, we will not be able to extend working life, the economic backbone of the state, municipalities, and cities will be broken, and the base of the national defence (the reserve army) will not hold up. The steady decline in fitness and increase in obesity will cause problems across all sectors of government. No amount of economic growth will be enough if the downward spiral of the physical functional capacity and fitness of working-age Finns is not reversed. We need multiple, simultaneous, effective measures across all sectors, at the national as well as the local level. These simultaneous, multi-sectoral actions require strong leadership and coordination between different sectors. Therefore, at the national level, the Prime Minister's Office and, at the local level, the municipal or city management group, are capable actors to lead these simultaneous measures that are needed across sectors of government. Effective measures are needed for those in the working life today who are struggling with their physical functional capacity, as well as to ensure the functional capacity of the workforce in the future. This policy brief is the second in its series from the Healthy Lifestyles to Boost Sustainable Growth (STYLE) project, combining interdisciplinary knowledge on trends in transport and physical activity. Interpreting them through infrastructure and service designs and changing lifestyles, we generate insight on novel business opportunities and intervention models that induce physical activity. This provides innovative pathways towards current national policy targets and promotion of the societal vision. The project is funded by the Strategic Research Council at the Academy of Finland. Read more: www.styletutkimus.fi/e

Kunnon rapistuminen haastaa hyvinvointi-Suomen – vaikuttavia toimia lisätä liikkumista ja kääntää kunnon laskukierre

Suomalaisten kunto rapistuu. Varusmiespalveluksen aloittajien kestävyyskunto on heikentynyt asteittain 1970-luvun lopulta nykypäivään. Huonokuntoisia varusmiehiä on jo kolmasosa palveluksen aloittajista, määrä on kahdeksankertaistunut. Keskimääräinen paino puolestaan on noussut kahdeksan kiloa. Kestävyyskunto heikentyy edelleen noin neljänneksen työuran aikana. Maltillinen ennuste kertoo kunnon heikentymisen jatkuvan lähivuosina. Tämä kehitys haastaa hyvinvointi-Suomen. Esitämme tässä STYLE-tutkimushankkeen politiikkasuosituksessa valtakunnallisen ja paikallisen tason toimia, joita samanaikaisesti toteuttamalla kestävyyskunnon lasku voidaan pysäyttää ja edelleen kääntää nousu-uralle. Liikunnallinen elämäntapa kestävän kasvun aikaansaajana (STYLE) tutkii kestävän kasvun edellytyksiä arkiliikunnan edistämisen keinoin. Hanke tukee liikenne- ja viestintäministeriön kävelyn ja pyöräilyn edistämisohjelman tavoitetta nostaa kävelyn ja pyöräilyn yhteistä kulkutapaosuutta 38 prosenttiin vuoteen 2030 mennessä. Tutkimusta rahoittaa strategisen tutkimuksen neuvosto, joka toimii Suomen Akatemian yhteydessä. Tutustu tarkemmin hankkeeseen: www.styletutkimus.f

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Two out of three of octogenarians benefitted from delayed resection of spinal meningiomas

BACKGROUND: Can elderly patients with thoracic meningioma and severe paraparesis benefit from delayed surgery? CASE DESCRIPTION: Two out of three octogenarians with severe preoperative paraparesis (all wheelchair-bound) were able to walk again following delayed (60–120 days from onset of deficit) surgical resection of thoracic spinal meningiomas. CONCLUSION: Two out of three octogenarians with thoracic meningiomas causing severe paraparesis benefitted from the delayed (i.e. from 60 to 289 days) surgical resection of their tumors

Small amount of alcohol did not deteriorate microsurgical dexterity : a prospective laboratory study

BackgroundAlcohol consumption has been reported to deteriorate surgical performance both immediately after consumption as well as on the next day. We studied the early effects of alcohol consumption on microsurgical manual dexterity in a laboratory setting.MethodSix neurosurgeons or neurosurgical residents (all male) performed micro- and macro suturing tasks after consuming variable amounts of alcohol. Each participant drank 0-4 doses of alcohol (14 g ethanol). After a delay of 60-157 min, he performed a macrosurgical and microsurgical task (with a surgical microscope). The tasks consisted of cutting and re-attaching a circular latex flap (diameter: 50 mm macrosuturing, 4 mm microsuturing) with eight interrupted sutures (4-0 multifilament macrosutures, 9-0 monofilament microsutures). We measured the time required to complete the sutures, and the amplitude and the frequency of physiological tremor during the suturing. In addition, we used a four-point ordinal scale to rank the quality of the sutures for each task. Each participant repeated the tasks several times on separate days varying the pre-task alcohol consumption (including one sober task at the end of the data collection).ResultsA total of 93 surgical tasks (47 macrosurgical, 46 microsurgical) were performed. The fastest microsurgical suturing (median 11 min 49 s, [interquartile range (IQR) 654 to 761 s]) was recorded after three doses of alcohol (median blood alcohol level 0.32 parts per thousand). The slowest microsurgical suturing (median 15 min 19 s, [IQR 666 to 1121 s]) was observed after one dose (median blood alcohol level 0 parts per thousand). The quality of sutures was the worst (mean 0.70 [standard deviation (SD) 0.48] quality points lost) after three doses of alcohol and the best (mean 0.33 [SD 0.52] quality points lost) after four doses (median blood alcohol level 0.44 parts per thousand).ConclusionsConsuming small amount of alcohol did not deteriorate microsurgical performance in our study. An observed reduction in physiological tremor may partially explain this.Peer reviewe

Personalised eHealth intervention to increase physical activity and reduce sedentary behaviour in rehabilitation after cardiac operations: study protocol for the PACO randomised controlled trial (NCT03470246)

IntroductionPersonalized intervention to increase physical Activity and reduce sedentary behaviour in rehabilitation after Cardiac Operations (PACO) is a smartphone-based and accelerometer-based eHealth intervention to increase physical activity (PA) and reduce sedentary behaviour (SB) among patients recovering from cardiac surgery.DesignProspective randomised controlled trial.Methods and analysisThe present protocol describes a randomised controlled clinical trial to be conducted in the Heart Centres of Kuopio and Turku university hospitals. The trial comprises 540 patients scheduled for elective coronary artery bypass grafting, aortic valve replacement or mitral valve repair. The patients will be randomised into two groups. The control group will receive standard postsurgical rehabilitation guidance. The eHealth intervention group will be given the same guidance together with personalised PA guidance during 90 days after discharge. These patients will receive personalised daily goals to increase PA and reduce SB via the ExSedapplication. Triaxial accelerometers will be exploited to record patients’ daily accumulated PA and SB, and transmit them to the application. Using the accelerometer data, the application will provide online guidance to the patients and feedback of accomplishing their activity goals. The data will also be transmitted to the cloud, where a physiotherapist can monitor individual activity profiles and customise the subsequent PA and SB goals online. The postoperative improvement in patients’ step count, PA, exercise capacity, quality of sleep, laboratory markers, transthoracic echocardiography (TTE) parameters and quality of life, and reduction in SB and incidence of major cardiac events are investigated as outcomes.ConclusionsThe PACO intervention aims to build a personalised eHealth tool for the online tutoring of cardiac surgery patients.Trial registration numberNCT03470246