Publications by authors named "Tommi Kauko"

44 Publications

OPERATIVE VS. CONSERVATIVE TREATMENT OF SMALL NON-TRAUMATIC SUPRASPINATUS TEARS IN PATIENTS OVER 55 YEARS: OVER 5-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL.

Authors:
Juha Kukkonen Anssi Ryösä Antti Joukainen Janne Lehtinen Tommi Kauko Kimmo Mattila Ville Äärimaa

J Shoulder Elbow Surg 2021 Mar 24. Epub 2021 Mar 24.

Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.

Background: Non-traumatic rotator cuff tear is a common shoulder problem which can be treated either conservatively or operatively. In the previous publications of the 1 and 2-year results of this trial, we found no significant between group clinical differences. The aim of this study was to investigate the difference in mid-term clinical and radiological outcomes in patients aged over 55 years.

Materials And Methods: 180 shoulders with symptomatic, non-traumatic supraspinatus tears were randomly assigned to one of the three cumulatively designed treatment groups: physiotherapy (Group 1), acromioplasty and physiotherapy (Group 2) and rotator cuff repair, acromioplasty and physiotherapy (Group 3). The change in Constant score was the primary outcome measure. Secondary outcome measures were change in visual analog scale for pain and patient satisfaction. Radiological analysis included evaluation of glenohumeral osteoarthritis and rotator cuff tear arthropathy.

Results: 150 shoulders (mean age 71) were available for analysis after a mean follow-up of 6.2 years. The mean sagittal tear size of the supraspinatus tendon tear was at baseline 10 mm in all groups (p=0.33). Eight shoulders in Group 1 and two shoulders in Group 2 crossed over to rotator cuff repair during the follow-up. The mean baseline Constant score values were 57.1, 58.2 and 58.7, respectively (p=0.85). There were no significant differences (p=0.84) in the mean change of Constant score: 18.5 points in Group 1, 17.9 points in Group 2 and 20.0 points in Group 3. There were no statistically significant differences in the change of visual analog scale for pain (p=0.74) and patient satisfaction (p=0.83). At follow-up there were no statistically significant differences in the mean progression of glenohumeral osteoarthritis (p=0.538) or cuff tear arthropathy (p=0.485) between the groups. However, there was a statistically significant mean progression of glenohumeral osteoarthritis from baseline to follow-up in the trial population (p=0.0045).

Conclusions: On the basis of this study operative treatment is no better than conservative treatment with regard to small non-traumatic single tendon supraspinatus tears in patients over 55 years of age. Operative treatment does not protect against degeneration of the glenohumeral joint or cuff tear arthropathy. Conservative treatment is a reasonable option for the primary initial treatment of this condition.
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http://dx.doi.org/10.1016/j.jse.2021.03.133DOI Listing
March 2021

Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study.

Authors:
Minna Kallioinen Mika Valtonen Marko Peltoniemi Ville-Veikko Hynninen Tuukka Saarikoski Oki Söderholm Tommi Kauko Jenni Aittokallio

J Perioper Pract 2021 Jan 10:1750458920950662. Epub 2021 Jan 10.

Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland.

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.
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http://dx.doi.org/10.1177/1750458920950662DOI Listing
January 2021

Trends in the surgical management of vesicoureteral reflux in Finland in 2004-2014.

Authors:
Liisi Ripatti Hanna-Reeta Viljamaa Tommi Kauko Ville Kytö Päivi Rautava Jussi Sipilä Niklas Pakkasjärvi

Scand J Urol 2021 Feb 26;55(1):67-71. Epub 2020 Nov 26.

Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.

Objectives: Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA are scarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteral reflux (VUR) in Finland.

Methods: We analyzed national data from Finnish Care Register for Health Care on children (<16 years of age) surgically treated for VUR in 2004-2014.

Results: Endoscopic injections of the ureteral orifices were primarily performed for 1212 and open ureteral reimplantation for 272 children. The use of both types of surgery decreased during the study period ( = 0.0043 and  < 0.001, respectively). The median age at surgery for VUR was lower in those treated with open ureteral reimplantation than those with endoscopic injections of the ureteral orifices [3 and 4 years, respectively] ( = 0.0001). The length of hospital stay was significantly longer (median 9.9 days) with open ureteral reimplantation compared to that (median 1.3 days) with endoscopic injections ( < 0.0001) and did not change during the study period. Reoperations were significantly more common in patients who were primarily treated with endoscopic injections ( = 146/1072, 14%) than with ureteral reimplantation ( = 7/230, 3%) ( < 0.0001).

Conclusions: While the best treatment options for VUR remain debatable, operative treatment of VUR has become less common in Finland. HIGHLIGHTS Recent data on the trends of treatment of vesicoureteral reflux outside USA are scarce. Surgical treatment for vesicoureteral reflux decreased in Finland during the study period. The length of stay was longer but reoperations were needed less often with ureteral reimplantation compared to endoscopic injections.
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http://dx.doi.org/10.1080/21681805.2020.1849387DOI Listing
February 2021

Effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction: a randomized controlled trial.

Authors:
Pekka Karppi Anssi Ryösä Juha Kukkonen Tommi Kauko Ville Äärimaa

J Shoulder Elbow Surg 2020 Sep 9;29(9):1765-1774. Epub 2020 Jun 9.

Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland.

Background: The benefit of supervised physiotherapy after rotator cuff surgery is unclear. The aim of this randomized controlled trial was to assess the effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction.

Methods: Eighty patients with full-thickness supraspinatus tendon tears were randomly assigned to either supervised physiotherapy or home exercises only. The primary outcome measure was the Constant score at 12 months after surgery.

Results: A total of 70 patients were available for analyses at 1-year follow-up. There were no statistically significant differences in the primary outcome between the treatment groups.

Conclusion: Supervised physiotherapy after arthroscopic rotator cuff reconstruction does not provide additional benefit compared with home exercises alone at 1-year follow-up.
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http://dx.doi.org/10.1016/j.jse.2020.04.034DOI Listing
September 2020

Bankart versus Latarjet operation as a revision procedure after a failed arthroscopic Bankart repair.

Authors:
Sami Elamo Liisa Selänne Kaisa Lehtimäki Juha Kukkonen Saija Hurme Tommi Kauko Ville Äärimaa

JSES Int 2020 Jun 4;4(2):292-296. Epub 2020 May 4.

Division of Musculoskeletal Diseases, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.

Background: An arthroscopic Bankart operation is the most common operative procedure to treat shoulder instability. In case of recurrence, both Bankart and Latarjet procedures are used as revision procedures. The purpose of this study was to compare the re-recurrence rate of instability and clinical results after arthroscopic revision Bankart and open revision Latarjet procedures following failed primary arthroscopic Bankart operations.

Methods: Consecutive patients operatively treated for shoulder instability at Turku University Hospital between 2002 and 2013 were analyzed. Patients who underwent a primary arthroscopic Bankart operation followed by a recurrence of instability and underwent a subsequent arthroscopic Bankart or open Latarjet revision operation with a minimum of 1 year of follow-up were called in for a follow-up evaluation. The re-recurrence of instability, Subjective Shoulder Value, and Western Ontario Shoulder Instability index were assessed.

Results: Of 69 patients, 48 (dropout rate, 30%) were available for follow-up. Recurrent instability symptoms occurred in 13 patients (43%) after the revision Bankart procedure and none after the revision Latarjet procedure. A statistically and clinically significant difference in the Western Ontario Shoulder Instability index was found between the patients after the revision Bankart and revision Latarjet operations (68% and 88%, respectively;  = .0166).

Conclusions: The redislocation rate after an arthroscopic revision Bankart operation is high. Furthermore, patient-reported outcomes remain poor after a revision Bankart procedure compared with a revision Latarjet operation. We propose that in cases of recurring instability after a failed primary Bankart operation, an open Latarjet revision should be considered.
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http://dx.doi.org/10.1016/j.jseint.2020.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256887PMC
June 2020

Qualitative and Quantitative Reporting of a Unique Biparametric MRI: Towards Biparametric MRI-Based Nomograms for Prediction of Prostate Biopsy Outcome in Men With a Clinical Suspicion of Prostate Cancer (IMPROD and MULTI-IMPROD Trials).

Authors:
Ileana Montoya Perez Ivan Jambor Tommi Kauko Janne Verho Otto Ettala Ugo Falagario Harri Merisaari Aida Kiviniemi Pekka Taimen Kari T Syvänen Juha Knaapila Marjo Seppänen Antti Rannikko Jarno Riikonen Markku Kallajoki Tuomas Mirtti Tarja Lamminen Jani Saunavaara Tapio Pahikkala Peter J Boström Hannu J Aronen

J Magn Reson Imaging 2020 05 21;51(5):1556-1567. Epub 2019 Nov 21.

Department of Diagnostic Radiology, University of Turku, Turku, Finland.

Background: Multiparametric MRI of the prostate has been shown to improve the risk stratification of men with an elevated prostate-specific antigen (PSA). However, long acquisition time, high cost, and inter-center/reader variability of a routine prostate multiparametric MRI limit its wider adoption.

Purpose: To develop and validate nomograms based on unique rapid biparametric MRI (bpMRI) qualitative and quantitative derived variables for prediction of clinically significant cancer (SPCa).

Study Type: Retrospective analyses of single (IMPROD, NCT01864135) and multiinstitution trials (MULTI-IMPROD, NCT02241122).

Population: 161 and 338 prospectively enrolled men who completed the IMPROD and MULTI-IMPROD trials, respectively.

Field Strength/sequence: IMPROD bpMRI: 3T/1.5T, T -weighted imaging, three separate diffusion-weighted imaging (DWI) acquisitions: 1) b-values 0, 100, 200, 300, 500 s/mm ; 2) b values 0, 1500 s/mm ; 3) values 0, 2000 s/mm .

Assessment: The primary endpoint of the combined trial analysis was the diagnostic accuracy of the combination of IMPROD bpMRI and clinical variables for detection of SPCa.

Statistical Tests: Logistic regression models were developed using IMPROD trial data and validated using MULTI-IMPROD trial data. The model's performance was expressed as the area under the curve (AUC) values for the detection of SPCa, defined as ISUP Gleason Grade Group ≥2.

Results: A model incorporating clinical variables had an AUC (95% confidence interval) of 0.83 (0.77-0.89) and 0.80 (0.75-0.85) in the development and validation cohorts, respectively. The corresponding values for a model using IMPROD bpMRI findings were 0.93 (0.89-0.97), and 0.88 (0.84-0.92), respectively. Further addition of the quantitative DWI-based score did not improve AUC values (P < 0.05).

Data Conclusion: A prediction model using qualitative IMPROD bpMRI findings demonstrated high accuracy for predicting SPCa in men with an elevated PSA. Online risk calculator: http://petiv.utu.fi/multiimprod/ Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1556-1567.
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http://dx.doi.org/10.1002/jmri.26975DOI Listing
May 2020

Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: A prospective multi-institutional trial.

Authors:
Ivan Jambor Janne Verho Otto Ettala Juha Knaapila Pekka Taimen Kari T Syvänen Aida Kiviniemi Esa Kähkönen Ileana Montoya Perez Marjo Seppänen Antti Rannikko Outi Oksanen Jarno Riikonen Sanna Mari Vimpeli Tommi Kauko Harri Merisaari Markku Kallajoki Tuomas Mirtti Tarja Lamminen Jani Saunavaara Hannu J Aronen Peter J Boström

PLoS Med 2019 06 3;16(6):e1002813. Epub 2019 Jun 3.

Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.

Background: Magnetic resonance imaging (MRI) combined with targeted biopsy (TB) is increasingly used in men with clinically suspected prostate cancer (PCa), but the long acquisition times, high costs, and inter-center/reader variability of routine multiparametric prostate MRI limit its wider adoption.

Methods And Findings: The aim was to validate a previously developed unique MRI acquisition and reporting protocol, IMPROD biparametric MRI (bpMRI) (NCT01864135), in men with a clinical suspicion of PCa in a multi-institutional trial (NCT02241122). IMPROD bpMRI has average acquisition time of 15 minutes (no endorectal coil, no intravenous contrast use) and consists of T2-weighted imaging and 3 separate diffusion-weighed imaging acquisitions. Between February 1, 2015, and March 31, 2017, 364 men with a clinical suspicion of PCa were enrolled at 4 institutions in Finland. Men with an equivocal to high suspicion (IMPROD bpMRI Likert score 3-5) of PCa had 2 TBs of up to 2 lesions followed by a systematic biopsy (SB). Men with a low to very low suspicion (IMPROD bpMRI Likert score 1-2) had only SB. All data and protocols are freely available. The primary outcome of the trial was diagnostic accuracy-including overall accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value-of IMPROD bpMRI for clinically significant PCa (SPCa), which was defined as a Gleason score ≥ 3 + 4 (Gleason grade group 2 or higher). In total, 338 (338/364, 93%) prospectively enrolled men completed the trial. The accuracy and NPV of IMPROD bpMRI for SPCa were 70% (113/161) and 95% (71/75) (95% CI 87%-98%), respectively. Restricting the biopsy to men with equivocal to highly suspicious IMPROD bpMRI findings would have resulted in a 22% (75/338) reduction in the number of men undergoing biopsy while missing 4 (3%, 4/146) men with SPCa. The main limitation is uncertainty about the true PCa prevalence in the study cohort, since some of the men may have PCa despite having negative biopsy findings.

Conclusions: IMPROD bpMRI demonstrated a high NPV for SPCa in men with a clinical suspicion of PCa in this prospective multi-institutional clinical trial.

Trial Registration: ClinicalTrials.gov NCT02241122.
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http://dx.doi.org/10.1371/journal.pmed.1002813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546206PMC
June 2019

Nasal microbiota clusters associate with inflammatory response, viral load, and symptom severity in experimental rhinovirus challenge.

Authors:
Markus J Lehtinen Ashley A Hibberd Sofia Männikkö Nicolas Yeung Tommi Kauko Sofia Forssten Liisa Lehtoranta Sampo J Lahtinen Buffy Stahl Anna Lyra Ronald B Turner

Sci Rep 2018 07 30;8(1):11411. Epub 2018 Jul 30.

University of Virginia, School of Medicine, P.O. Box 800386, Barringer Building, Room 4441, Hospital Drive, Charlottesville, VA, 22908, USA.

The role of nasal and fecal microbiota in viral respiratory infections has not been established. We collected nasal swabs and washes, and fecal samples in a clinical study assessing the effect of probiotic Bifidobacterium animalis subsp. lactis Bl-04 on experimental rhinovirus infection. The nasal and fecal microbiota were characterized by 16S rRNA gene sequencing. The resulting data were compared with nasal inflammatory marker concentrations, viral load, and clinical symptoms. By using unsupervised clustering, the nasal microbiota divided into six clusters. The clusters predominant of Staphylococcus, Corynebacterium/Alloiococcus, Moraxella, and Pseudomonadaceae/Mixed had characteristic inflammatory marker and viral load profiles in nasal washes. The nasal microbiota clusters of subjects before the infection associated with the severity of clinical cold symptoms during rhinovirus infection. Rhinovirus infection and probiotic intervention did not significantly alter the composition of nasal or fecal microbiota. Our results suggest that nasal microbiota may influence the virus load, host innate immune response, and clinical symptoms during rhinovirus infection, however, further studies are needed.
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http://dx.doi.org/10.1038/s41598-018-29793-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065324PMC
July 2018

Risks and prevalence of pressure ulcers among patients in an acute hospital in Finland.

Authors:
Marita Koivunen Anna Hjerppe Eija Luotola Tommi Kauko Paula Asikainen

J Wound Care 2018 Feb;27(Sup2):S4-S10

Administrative Nursing Director, Adjunct Professor, Department of Biostatistics, University of Turku, and School of Health Sciences, University of Tampere, Satakunta Hospital District.

Objective: To quantify pressure ulcer (PU) prevalence and to describe and identify the PU risk factors in acute hospital wards.

Method: A descriptive quantitative study was performed in 13 wards in a central hospital in Finland. The study included PU risk evaluation using the Braden risk assessment method, and full skin and medical assessment of consenting adult patients. Patients in paediatric, maternity and psychiatric wards, and in the intensive care unit were excluded. Patient's PUs were examined on the ward, and evaluated and classified using the international European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (EPUAP/NPUAP) Pressure Ulcer Classification System. Demographic data, the Braden risk assessment scale, skin assessment, and the location and severity of PUs were also recorded.

Results: A sample of 229 inpatients was examined for signs of PUs on one day in 2013. The overall PU prevalence was 8.7% (20 patients). Of those assessed as 'at risk of developing PUs', four patients (1.7%) were considered at 'very high risk', 39 patients (17.0%) at 'high risk', and 60 patients (26.2%) with a 'moderate risk'. The patient's age and length of treatment period were associated with PU risk, while only length of treatment period was associated with PU prevalence. Older patients had a higher risk of PUs than younger ones. The longer the hospital stay, the higher the PU risk was. In addition, patients with a long hospital stay more often had a PU.

Conclusion: According to the study, PUs occur with significant frequency in acute hospital wards. It is important to carry out PU prevention actions among all patient groups, but risk increases among older patients and those who, for any reason, stay in hospital for a longer period of time.
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http://dx.doi.org/10.12968/jowc.2018.27.Sup2.S4DOI Listing
February 2018

Comparison of mid-age-onset and late-onset Huntington's disease in Finnish patients.

Authors:
Jussi O T Sipilä Tommi Kauko Markku Päivärinta Kari Majamaa

J Neurol 2017 Oct 28;264(10):2095-2100. Epub 2017 Aug 28.

Unit of Neuroscience, Neurology, University of Oulu, Oulu, Finland.

The phenotype of juvenile Huntington's disease (HD) differs clearly from that of adult-onset HD, but information about differences between mid-age-onset HD and late-onset HD (LOHD) is scarce. A national cohort of 206 patients with adult-onset HD was identified using national registries and patient records. LOHD was defined as age ≥60 years at HD diagnosis. Genetic disease burden was assessed using CAG age product (CAP) score. LOHD comprised 25% of the adult-onset HD cohort giving a point prevalence of 2.38/100,000 in the Finnish population at least 60 years of age. The proportion of LOHD out of new HD diagnoses increased from 21% in 1991-2000 to 33% in 2001-2010. At the time of diagnosis, patients with LOHD had 10.4 units (95% CI 4.8-15.9; p = 0.0003) higher CAP scores, more severe motor impairment and slightly more severe functional impairment than that in patients with mid-age-onset HD. There was no difference in the rate of disease progression or survival between LOHD and mid-age-onset patients. The lifespans of deceased patients were shorter in mid-age-onset HD (p < 0.001) and LOHD (p = 0.002) than their life expectancies. Causes of death differed between the two patient groups (p = 0.025). LOHD comprises a quarter of Finnish HD patients and the proportion appears to be increasing. Our results did not reveal differences in the phenotype between mid-age-onset HD and LOHD, but prospective studies are needed.
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http://dx.doi.org/10.1007/s00415-017-8600-2DOI Listing
October 2017

Novel biparametric MRI and targeted biopsy improves risk stratification in men with a clinical suspicion of prostate cancer (IMPROD Trial).

Authors:
Ivan Jambor Peter J Boström Pekka Taimen Kari Syvänen Esa Kähkönen Markku Kallajoki Ileana Montoya Perez Tommi Kauko Jaakko Matomäki Otto Ettala Harri Merisaari Aida Kiviniemi Peter B Dean Hannu J Aronen

J Magn Reson Imaging 2017 10 6;46(4):1089-1095. Epub 2017 Feb 6.

Department of Diagnostic Radiology, University of Turku, Turku, Finland.

Purpose: To evaluate the role of a 3T biparametric magnetic resonance imaging (bpMRI), T -weighted imaging, and three separate diffusion-weighted imaging acquisitions combined with targeted biopsy (TB) for improving risk stratification of men with elevated prostate-specific antigen (PSA).

Materials And Methods: Between March 2013 and February 2015, 175 men with a clinical suspicion of prostate cancer (PCa) were offered bpMRI (NCT01864135) based on a suspicion of PCa (two repeated PSA measurements in the range 2.5-20.0 ng/ml and/or abnormal digital rectal examination). Men with an equivocal to high suspicion of PCa had two TBs of the dominant lesion using cognitive ultrasound guidance, followed by systematic biopsy (SB). Men with a low to very low suspicion had only SB. In total, 161 (161/175, 92%) prospectively enrolled men completed the trial and were included in the final analyses. The primary endpoint of the trial was the cancer detection rate (CDR) of TB and SB. Clinically significant cancer (SPCa) was defined as Gleason score ≥3 + 4.

Results: TB compared with SB had higher CDR for SPCa (45%, 72/161 vs. 39%, 63/161, respectively; P > 0.05) and a lower CDR for Gleason score 3 + 3 (8%, 15/161 vs. 16%, 30/161; P < 0.05). Restricting biopsy to men with equivocal to highly suspicious bpMRI findings would have resulted in a 24% (38/161) reduction in the number of men undergoing biopsy, while missing 4 (2%) with SPCa. All anonymized datasets, including bpMRI reports and follow up information, are freely available on the trial server.

Conclusion: Prebiopsy bpMRI and TB in men with a clinical suspicion of PCa improved risk stratification.

Level Of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:1089-1095.
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http://dx.doi.org/10.1002/jmri.25641DOI Listing
October 2017

Assessment of Pain Drawings and Self-Reported Comorbid Pains as Part of the Biopsychosocial Profiling of Temporomandibular Disorder Pain Patients.

Authors:
Tuija I Suvinen Pentti Kemppainen Yrsa Le Bell Tommi Kauko Heli Forssell

J Oral Facial Pain Headache 2016 Fall;30(4):287-295

Aims: To assess drawings of pain sites and self-reported comorbid pains as a part of the biopsychosocial profiling of tertiary care referral patients with temporomandibular disorder (TMD) pain.

Methods: A total of 135 consecutive patients referred to tertiary care for TMD pain participated. Patients drew all the sites where they had pain on whole-body pain drawings. Other assessments included self-reported comorbid pains in the head and body regions, the Finnish Research Diagnostic Criteria for TMD (RDC/TMD_FIN Axis II), and additional biopsychosocial and treatment-related variables. Patients were grouped into pain drawing profiles (localized, regional, and widespread) and the associations between these profiles and the biopsychosocial variables were statistically evaluated using Bonferroni adjusted P values and with logistic regression using SAS 9.3.

Results: A total of 21% of the patients reported localized TMD pain, 20% reported regional pain (headaches and neckaches), and the majority, 59%, reported widespread pain (local/regional and multiple bodily pain sites). Patients with widespread pain profiles formed a heterogenous group in which 28.2% reported severe and 30.8% reported moderate pain-related disability. The widespread pain patients reported significantly higher levels of depression and somatization, lower levels of general health, more sleep dysfunction, decreased ability to control pain, and greater health care needs compared to patients with localized pain (P < .05). Patients with regional pain profiles reported moderate scores on psychosocial functioning compared to the patients with localized or widespread pain.

Conclusion: The majority of tertiary care referral patients with TMD pain reported comorbid pains. Pain drawings were found a useful adjunctive tool for screening and as a part of comprehensive biopsychosocial assessment and treatment planning for patients with TMD pain.
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http://dx.doi.org/10.11607/ofph.1589DOI Listing
August 2017

Seasonality of stroke in Finland.

Authors:
Jussi O T Sipilä Jori O Ruuskanen Tommi Kauko Päivi Rautava Ville Kytö

Ann Med 2017 06 29;49(4):310-318. Epub 2016 Nov 29.

i Heart Center, Turku University Hospital , Turku , Finland.

Introduction: The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent.

Methods: A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004-2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH).

Results: The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality.

Conclusions: All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982-1992.
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http://dx.doi.org/10.1080/07853890.2016.1254350DOI Listing
June 2017

Induced abortion - impact on a subsequent pregnancy in first-time mothers: a registry-based study.

Authors:
Susanna Holmlund Tommi Kauko Jaakko Matomäki Miia Tuominen Juha Mäkinen Päivi Rautava

BMC Pregnancy Childbirth 2016 10 24;16(1):325. Epub 2016 Oct 24.

Department of Public Health, University of Turku, 20014, Turun yliopisto, Finland.

Background: To date, several studies concerning the effects of induced abortion (IA) on women's later psychosocial well-being and future delivery complications have been published. However, the lack of reports on woman's physical well-being during their first full-term pregnancy occurring after IA is what inspired the current study. Here, we evaluate the physical well-being and use of maternity services of first-time mothers with a history of IA.

Methods: Finnish National Birth Registry data from 2008 to 2010 were linked with the Induced Abortion Registry data from 1983 to 2007. After excluding first-time mothers with a history of miscarriage, ectopic pregnancy or delivery, 57,406 mothers were eligible for the study, with 5,167 (9.0 %) having experienced prior IA. Data from the pregnancy follow-up visits were evaluated and compared between IA mothers and primiparous mothers.

Results: Women with IA had higher rates of smoking after the first trimester and were more likely to be overweight (body mass index >25 kg/m) than the control group mothers. A higher use of maternity health clinic (MHC) services, thrombosis prophylaxis and participation in a second trimester ultrasound and amniotic fluid sample testing were evident in IA mothers, whereas the likelihood of assisted fertilisation procedure(s) was elevated in the control group. A shorter interpregnancy interval (IPI) seemed to contribute to a late first MHC visit and first trimester serum screening test participation, a higher incidence of placenta samples and an increased presence of preeclampsia and maternal care for poor foetal growth.

Conclusions: IA is associated with being overweight before the subsequent pregnancy and with smoking after the first trimester. More frequent pregnancy follow-up visits in the IA group may be due to greater participation in the placenta sample testing and use of thrombosis prophylaxis. No association between IA and preeclampsia, hypertension, gestational diabetes or preterm premature rupture of membranes was evident in the pregnancy parameters. According to our findings, experiencing IA decreased the need for fertilisation procedures before the next pregnancy when compared to primiparous mothers. Among the IA mothers, the short IPI seemed to contribute to the higher risk for preeclampsia and maternal care for poor foetal growth. However, more research is needed around the IPI before establishing its effect on later pregnancy.
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http://dx.doi.org/10.1186/s12884-016-1109-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078979PMC
October 2016

Cerebrospinal fluid cytokines in Lyme neuroborreliosis.

Authors:
Annukka Pietikäinen Mikael Maksimow Tommi Kauko Saija Hurme Marko Salmi Jukka Hytönen

J Neuroinflammation 2016 10 18;13(1):273. Epub 2016 Oct 18.

Department of Medical Microbiology and Immunology, University of Turku, Kiinamyllynkatu 13, FI-20520, Turku, Finland.

Background: Lyme neuroborreliosis (LNB) is one of the manifestations of Lyme disease. Although it is known that immune reaction of LNB patients is dominated by Th1 and Th2 responses and patients have elevated numbers of B cells in their cerebrospinal fluid (CSF), not all the cells involved in inflammation and cytokine secretion have been characterized. The current diagnostics of LNB is based on intrathecal production of antibodies. In recent years, the measurement of chemokine CXCL13 concentration from the CSF has been introduced as a new promising diagnostic tool for LNB to complement the antibody-based diagnostic methods. A few other cytokines have also been analyzed as possible diagnostic markers. However, multiplex analyses simultaneously evaluating the concentrations of a large number of different cytokines in the CSF of LNB patients have been lacking thus far. Extensive cytokine profiling CSF samples of LNB patients would also help in understanding the complex immunopathogenesis of LNB.

Methods: CSF samples were analyzed from 43 LNB patients, 19 controls, 18 tick-borne encephalitis patients, and 31 multiple sclerosis patients. In addition, CSF samples from 23 LNB patients obtained after the antibiotic treatment were examined. Altogether, the concentrations of 49 different cytokines were determined from all of the samples. The concentrations of 48 different cytokines were analyzed by magnetic bead suspension array using the Bio-Plex Pro Human Cytokine 21- and 27-plex panels, and the concentration of CXCL13 was analyzed by an ELISA based method.

Results: Distinct cytokine profiles which were able to distinguish LNB patients from controls, tick-borne encephalitis patients, multiple sclerosis patients, and LNB patients treated with antibiotics were identified. LNB patients had elevated concentrations of all major T helper cell type cytokines (Th1, Th2, Th9, Th17, and Treg) in their CSF.

Conclusions: Despite the great differences in the CSF cytokine profiles of different patient groups, CXCL13 still remained as the best marker for LNB. However, IL-1ra might also be helpful as a marker for the antibiotic treatment response. Concerning the immunopathogenesis, this is the first report suggesting the involvement of Th9 cells in the immune response of LNB.
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http://dx.doi.org/10.1186/s12974-016-0745-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070144PMC
October 2016

Alcohol risk drinking, quality of life and health state among patients treated at the Sobering Unit in the emergency department - One year follow-up study.

Authors:
Marita Koivunen Sanna Harju Tommi Kauko Maritta Välimäki

Int Emerg Nurs 2017 Mar 27;31:22-29. Epub 2016 Jun 27.

University of Turku, Department of Nursing Science/Turku University Hospital/The Hong Kong Polytechnic University, School of Nursing, FI-20014 University of Turku, Finland. Electronic address:

Objectives: To evaluate impacts of brief intervention on patients' alcohol risk drinking, quality of life and health state after treatment at the Sobering Unit in the emergency department at three months, six months, and one year follow-up.

Methods: This was a quasi-experimental study without control group (one-year follow-up). Alcohol use of patients in emergency department (Sobering Unit) in specialized care in Finland (AUDIT-test), quality of life (EQ-5D-3L) and health state (EQ VAS) at baseline, three months, six months and one year following the brief intervention were analyzed with Wilcoxon Signed-Rank test.

Results: The patients' alcohol risk use decreased statistically significantly after the treatment period at the Sobering Unit. The patients' health-related quality of life did not change statistically significantly during three months following the treatment period, whereas a statistically significant increase took place after six months. Self-perceived health status improved statistically significantly between the treatment period and three- and six-month follow up time points.

Conclusions: The study gave some suggestive evidence that a brief intervention could be effective for harmful drinkers or alcohol-dependent patients when used in an emergency department. The Sobering Unit in the emergency department is one solution to encourage patients to pay attention to their alcohol risk drinking.
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http://dx.doi.org/10.1016/j.ienj.2016.06.003DOI Listing
March 2017

Salivary antimicrobial defensins in pregnancy.

Authors:
Mervi Gürsoy Ulvi K Gürsoy Anna Liukkonen Tommi Kauko Saara Penkkala Eija Könönen

J Clin Periodontol 2016 10 18;43(10):807-15. Epub 2016 Jul 18.

Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland.

Aim: Susceptibility to and severity of gingival inflammation are enhanced during pregnancy; however, regulation of oral innate immune response, including antimicrobial peptides, during pregnancy is still unknown. We analysed salivary levels of human beta-defensin (hBD)-1, -2, -3, and human neutrophil peptide (HNP)-1 in pregnant women, and related those to their periodontal status.

Material And Methods: In this cohort study, 30 generally healthy, non-smoking Caucasian women without periodontitis were followed at three time points during pregnancy and twice post-partum. The non-pregnant group consisted of 24 women, who were examined three times at the following months. At each visit, periodontal status was recorded and stimulated saliva samples were collected. Salivary estradiol, progesterone, and defensin concentrations were measured by ELISA assays.

Results: After adjusting for visible plaque and gingival bleeding, reduced salivary concentrations of hBD-1, hBD-2, and HNP-1 were found especially during the third trimester, whereas hBD-3 concentrations did not change during pregnancy and post-partum visits. Weak associations were observed between salivary defensin and hormone concentrations and clinical parameters.

Conclusion: There seems to be an independent regulation cascade for each antimicrobial defensin in the oral cavity during pregnancy, despite of the similarities between these antimicrobial peptides.
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http://dx.doi.org/10.1111/jcpe.12581DOI Listing
October 2016

Effects of ospemifene, a novel selective estrogen-receptor modulator, on human breast tissue ex vivo.

Authors:
Natalija Eigeliene Lauri Kangas Christina Hellmer Tommi Kauko Risto Erkkola Pirkko Härkönen

Menopause 2016 07;23(7):719-30

1Department of Cell Biology and Anatomy, Institute of Biomedicine 2Department of Biostatistics, University of Turku, Finland 3Hormos Ltd, Turku, Finland 4IMC FH Krems, Austria 5Department of Obstetrics and Gynaecology, Turku University Central Hospital, Finland.

Objective: Ospemifene (Osp) is a novel selective estrogen-receptor modulator (SERM) accepted for the treatment of dyspareunia, a symptom of postmenopausal vulvovaginal atrophy. We aimed to analyze the effects of Osp on human breast tissue (HBT), in comparison with the clinically established SERMs raloxifene (Ral) and tamoxifen (Tam), using ex vivo explant cultures.

Methods: HBT samples were obtained from postmenopausal women undergoing mammoplasty and cultured with or without Osp, Ral, Tam, or 17β-estradiol (E2) for 7 and 14 days, and studied for morphology, proliferation, and apoptosis. The expression of epithelial markers, the estrogen-receptor alpha (ERα), the androgen receptor (AR), TFF1, and apolipoprotein D was evaluated using immunohistochemistry and quantitative reverse transcription-polymerase chain reaction. The PvuII polymorphism of ERS1 was determined.

Results: Osp, similar to Ral and Tam, decreased the number of proliferating cells in a concentration-dependent manner (at 100 nM, P < 0.01) and strongly opposed 10 nM E2-stimulated proliferation (P < 0.001). Corresponding effects were observed in the proportions of cells expressing ERα and TFF1 (P < 0.001). At 14 days apoptosis was increased by 100 nM SERMs (P < 0.01), but, notably, decreased by 1 nM Osp and Ral at day 7 (P < 0.05). The SERMs exerted ER-agonist effects on AR-positive cell populations at 1 nM (P < 0.05), but not at 100 nM concentrations. The effects on proliferation and ERα expressing cell numbers were associated with the ERS1 PvuII genotype.

Conclusions: In summary, Osp inhibited proliferation and opposed E2 stimulation in normal HBT in an efficacious, but less potent way than Ral and Tam. The ESR1 PvuII polymorphisms may influence the responsiveness of HBT to E2 and SERMs.
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http://dx.doi.org/10.1097/GME.0000000000000624DOI Listing
July 2016

Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial.

Authors:
Elina Lietzén Imre Ilves Paulina Salminen Hannu Paajanen Tero Rautio Pia Nordström Markku Aarnio Tuomo Rantanen Tommi Kauko Airi Jartti Juhani Sand Jukka-Pekka Mecklin Juha M Grönroos

Clin Chem Lab Med 2016 Oct;54(10):1691-7

Background: The current research on acute appendicitis aims to improve the diagnostics and to clarify to whom antibiotic treatment might be the treatment of choice.

Methods: The present study is a retrospective analysis of a prospectively collected data in our randomized multicenter trial comparing surgery and antibiotic treatment for acute uncomplicated appendicitis (APPAC trial, NCTO1022567). We evaluated 1321 patients with a clinical suspicion of acute appendicitis, who underwent computed tomography (CT). Age, gender, body temperature, pain scores, the duration of symptoms, white blood cell count (WBC) and C-reactive protein (CRP) were recorded on admission.

Results: CT confirmed the diagnosis of acute appendicitis in 73% (n=970) and in 27% (n=351) it revealed no or other diagnosis. Acute appendicitis patients had significantly higher WBC levels than patients without appendicitis (median 12.2 and 10.0, respectively, p<0.0001), whereas CRP levels did not differ between the two groups. Ideal cut-off points were assessed with receiver operating characteristic (ROC) curves, but neither these markers or neither their combination nor any clinical characteristic could accurately differentiate between patients with acute appendicitis and those without. The proportion of patients with normal WBC count and CRP was significantly (p=0.0007) lower in patients with acute appendicitis than in patients without appendicitis.

Conclusions: Both clinical findings and laboratory tests are unable to reliably distinguish between patients with acute appendicitis and those without. If both WBC count and CRP are normal, acute appendicitis is very unlikely. The current results emphasize the role of CT imaging in patients with suspected acute appendicitis.
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http://dx.doi.org/10.1515/cclm-2015-0981DOI Listing
October 2016

Admission sodium level and prognosis in adult Guillain-Barré syndrome.

Authors:
Jussi O T Sipilä Tommi Kauko Merja Soilu-Hänninen

Int J Neurosci 2017 Apr 31;127(4):344-349. Epub 2016 Mar 31.

a Division of Clinical Neurosciences , Turku University Hospital , Turku , Finland.

Purpose: Guillain-Barré syndrome (GBS) varies in severity and outcome. Hyponatremia predicts poor outcome but previous studies have used divergent methodology and (pseudo)hyponatremia caused by intravenous immunoglobulin administration may confound analysis. We studied if the plasma sodium level at admission was associated with GBS outcome.

Methods: All 69 patients at least 16 years of age treated for GBS in Turku University Hospital in 2004-2013 were included in the study. Clinical information was obtained from patient charts.

Results: Women had lower sodium levels at admission (138; IQR 135, 140) compared to men (140; IQR 138, 142; p = 0.0116) but no association of sodium levels with demographics, pre-hospital variables or basic GBS characteristics was found. Multivariate analyses showed lower admission sodium levels to be associated with worse functional status at one year from disease onset (OR 1.37; 95% CI 1.07-1.76; p = 0.0136) and probability of being discharged to another care facility from the hospital (OR 1.31; 95% CI 1.05-1.64; p = 0.0180) but not associated with need of intensive care unit care (p = 0.09) or mechanical ventilation (p = 0.45), length of hospital stay (p =0.48) or functional status at six months (p = 0.07).

Conclusions: Low plasma sodium level at admission is associated with a more severe disease course and a worse outcome in GBS independently of previously identified prognostic factors. Hyponatremia does not, however, appear to be caused by disease-specific factors.
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http://dx.doi.org/10.3109/00207454.2016.1163551DOI Listing
April 2017

Association of restaurant smoking ban and the incidence of acute myocardial infarction in Finland.

Authors:
Jussi Olli Tapani Sipilä Jarmo Mikael Gunn Tommi Kauko Päivi Rautava Ville Kytö

BMJ Open 2016 Jan 29;6(1):e009320. Epub 2016 Jan 29.

Heart Center, Turku University Hospital, Turku, Finland Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.

Objective: To describe the changes in nationwide acute myocardial infarction (AMI) incidence following the implementation of a law banning smoking indoors in restaurants on 1 June 2007.

Methods: Retrospective registry study of all hospitalisations for AMI in Finland. All 34,887 hospitalisations for AMI between 1 June 2005 and 31 May 2009 were identified from the Care Register for Health Care (CRHC) and statistics for tobacco consumption were obtained from the National Institute for Health and Welfare. Comorbidities for individual hospitalisations were searched from the CRHC.

Results: The incidence rate of AMI was reduced by 6.3% (95% CI 4.1% to 8.6%; p<0.0001) in the latter half of the study period following the smoking ban when adjusted for age, gender and overall population prevalence of smoking. Short-term incidence of AMI (6-month prior vs 6 months after the smoking ban) was also reduced (4.5%, 95% CI 0.2% to 9.0%; p=0.0399) and was largest in the working middle-aged group (40-50 years) but observed also in the oldest age group (>70 years). The incidence rates declined similarly for men and women.

Conclusions: Banning indoor tobacco smoking in restaurants was associated with a mild additional reduction in AMI incidence on a nationwide level in Finland.
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http://dx.doi.org/10.1136/bmjopen-2015-009320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735218PMC
January 2016

Explanatory Models of Illness and Treatment Goals in Temporomandibular Disorder Pain Patients Reporting Different Levels of Pain-Related Disability.

Authors:
Heli Forssell Ulla Kotiranta Tommi Kauko Tuija Suvinen

J Oral Facial Pain Headache 2016 ;30(1):14-20

Aims: To explore whether temporomandibular disorder (TMD) pain patients reporting different levels of pain-related disability differ in terms of illness explanations and treatment expectations.

Methods: Consecutive TMD pain patients (n = 399; mean ± SD age, 40.5 ± 12.7 years; 83% women) seeking treatment in primary care completed the Explanatory Model Scale (EMS). Patients were asked to indicate their expectations regarding the treatment. Each patient's pain-related disability level was determined using the Graded Chronic Pain Scale, with scores indicating no (0 disability points), low (1-2 disability points), or high (3-6 disability points) disability. Differences between EMS factor scores were evaluated using the Mann-Whitney U test. Differences between study groups were analyzed using logistic regression.

Results: High-disability patients considered physical and stress factors as more important in causing and in aggravating pain and as targets of treatment compared with patients with no disability (P = .0196 and P = .0251, respectively). The great majority of patients indicated they would like to receive information, decrease pain, and increase jaw function, with no significant subtype differences noted. Compared with no-disability patients, low-disability and high-disability patients were more likely to expect increased ability to perform daily functions (P < .0001 in both comparisons), increased work ability (P < .0001 in both comparisons), and better stress management skills (P = .0014 and P = .0001, respectively).

Conclusion: Illness explanations and goals for treatment differ in patients reporting different levels of TMD pain-related disability.
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http://dx.doi.org/10.11607/ofph.1482DOI Listing
March 2016

Treatment of adult acute myeloid leukemia.

Authors:
Joni Järvenpää Maija Itälä-Remes Tommi Kauko Urpu Salmenniemi Marjut Kauppila Mervi Putkonen Tommi Salmi Kari Remes

Duodecim 2016;132(16):1465-73

The aim of this study was to analyze the treatment results of 180 adult AML patients treated at Turku University Hospital from 2002 to 2012. 124 patients received intensive therapy according to the protocol of the Finnish Leukemia Group. 86% of them achieved remission. 46 patients underwent allogeneic stem cell transplantation which was beneficial for high and intermediate risk disease. 60 - 70% of patients under 60 years old can be cured. The genetic profile of the disease, patient age and treatment response had a significant impact on survival. Our treatment results are comparable with data in literature.
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January 2018

Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up.

Authors:
Juha Kukkonen Antti Joukainen Janne Lehtinen Kimmo T Mattila Esa K J Tuominen Tommi Kauko Ville Äärimaa

J Bone Joint Surg Am 2015 Nov;97(21):1729-37

Medical Imaging Centre of Southwest Finland (K.T.M. and E.K.J.T.) and Department of Orthopaedics and Traumatology (V.Ä.), Turku University Hospital, P.O. Box 28, 20701 Turku, Finland. E-mail address for K.T. Mattila: E-mail address for E.K.J. Tuominen: E-mail address for V. Äärimaa:

Background: The optimal treatment for symptomatic, nontraumatic rotator cuff tear is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this condition. We hypothesized that rotator cuff repair yields superior results compared with other treatment modalities.

Methods: One hundred and eighty shoulders with symptomatic, nontraumatic, supraspinatus tears were randomized into one of three cumulatively designed intervention groups: the physiotherapy-only group (denoted as Group 1), the acromioplasty and physiotherapy group (denoted as Group 2), and the rotator cuff repair, acromioplasty, and physiotherapy group (denoted as Group 3). The Constant score was the primary outcome measure. Secondary outcome measures were visual analog scale for pain, patient satisfaction, rotator cuff integrity in a control imaging investigation, and cost of treatment.

Results: One hundred and sixty-seven shoulders (160 patients) were available for analysis at two years. There were no significant differences (p = 0.38) in the mean change of Constant score: 18.4 points (95% confidence interval, 14.2 to 22.6 points) in Group 1, 20.5 points (95% confidence interval, 16.4 to 24.6 points) in Group 2, and 22.6 points (95% confidence interval, 18.4 to 26.8 points) in Group 3. There were no significant differences in visual analog scale for pain scores (p = 0.45) and patient satisfaction (p = 0.28) between the groups. At two years, the mean sagittal size of the tendon tear was significantly smaller (p < 0.01) in Group 3 (4.2 mm) compared with Groups 1 and 2 (11.0 mm). Rotator cuff repair and acromioplasty were significantly more expensive than physiotherapy only (p < 0.01).

Conclusions: There was no significant difference in clinical outcome between the three interventions at the two-year follow-up. The potential progression of the rotator cuff tear, especially in the non-repaired treatment groups, warrants further follow-up. On the basis of our findings, conservative treatment is a reasonable option for the primary initial treatment for isolated, symptomatic, nontraumatic, supraspinatus tears in older patients.

Level Of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.N.01051DOI Listing
November 2015

Finding specific 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 cut-off values for disease activity levels in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study.

Authors:
Maria Backström Pirjo Tynjälä Heikki Ylijoki Kristiina Aalto Johanna Kärki Heini Pohjankoski Paula Keskitalo Sirja Sard Maiju Hietanen Helena Lehto Tommi Kauko Paula Vähäsalo

Rheumatology (Oxford) 2016 Apr 7;55(4):615-23. Epub 2015 Oct 7.

Medical Research Center Oulu, Department of Children and Adolescents, Oulu University Hospital and PEDEGO Research Center, University of Oulu and.

Objectives: To establish the cut-off values for inactive disease, as well as low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in non-systemic JIA based on the Juvenile Arthritis Disease Activity Score (JADAS) and assessed with the 10-joint JADAS (JADAS10) and clinical JADAS10 (cJADAS10).

Methods: In a multicentre cross-sectional study consisting of ∼20% of all patients with JIA in Finland (n = 509), we obtained data on their most recent registered visits between January 2013 and January 2014. We calculated the JADAS10 and cJADAS10 and established the cut-off values of both of these scores using two different receiver operating characteristics-based statistical methods.

Results: Of the 509 patients studied, 65.8% were females and 53.8% had polyarticular disease. The most suitable method for determining cut-off values was the Youden index. In oligoarticular patients, a JADAS10 score of 0-0.5 represented inactive disease, 0.6-2.7 LDA and ≥2.8 MDA. In polyarticular disease, a JADAS10 score of 0-0.7 represented inactive disease, 0.8-3.9 LDA and ≥4.0 MDA. The cut-off values for HDA were not possible to establish because only two visits fulfilled HDA criteria.

Conclusion: We established cut-off values for LDA and MDA. A reliable definition for HDA will require more patients. In the clinical setting, both the cJADAS10 and JADAS10 serve equally well both for research and quality control purposes. In the future, uniform clinical disease activity levels should be established. We also suggest revising and validating the criteria for HDA. Valid and robust cut-off values for disease activity levels can guide both clinicians and researchers and equip them for quality control.
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http://dx.doi.org/10.1093/rheumatology/kev353DOI Listing
April 2016

Change in agreement between stroke survivors and their significant others on the severity of restrictions of functioning in a 1-year follow-up.

Authors:
Sinikka Tarvonen-Schröder Katri Laimi Tommi Kauko Mikhail Saltychev

Int J Rehabil Res 2015 Dec;38(4):327-32

aDepartment of Rehabilitation and Brain Trauma, Division of Clinical Neurosciences bDepartment of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku cDepartment of Biostatistics, University of Turku, Turku, Finland.

The aim of this study was to assess the agreement between stroke survivors and their significant others on the severity of restrictions of functioning and to investigate the change in this agreement in a 1-year follow-up. The 41 stroke survivors and their significant others assessed the severity of impairment at the end of in-patient interdisciplinary neurorehabilitation and 1 year later using a structured form based on International Classification of Functioning, Disability and Health (ICF). The main outcomes were as follows: (i) change in the severity score of each observer on a particular restriction (intraobserver change); (ii) change in difference in severity scores within each observer pair (interobserver change); and (iii) change in agreement between interobserver differences in severity scores during a 1-year follow-up. The significant others identified more restrictions at baseline (256 vs. 194 ICF categories, χ2 P=0.004) than the rehabilitants did. After 1 year, this difference became insignificant (218 vs. 207 ICF categories, χ2 P=0.59). The severity of perceived restrictions did not differ over time (all P>0.05). Although significant others rated the restrictions as slightly more severe than rehabilitants, the difference was not significant. The agreement between severity scores within observer pairs showed a tendency to improve during a 1-year follow-up. Statistically significant improvements in Cohen's κ agreement were found for muscle power (0.6-1.0), walking (0.7-0.9), eating (0.7-1.0) and immediate family support (0.5-0.8). The agreement between stroke survivors and their significant others on the severity of the restrictions of functioning showed a tendency to improve over time.
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http://dx.doi.org/10.1097/MRR.0000000000000130DOI Listing
December 2015

Tumor-Associated Macrophages Provide Significant Prognostic Information in Urothelial Bladder Cancer.

Authors:
Minna M Boström Heikki Irjala Tuomas Mirtti Pekka Taimen Tommi Kauko Annika Ålgars Sirpa Jalkanen Peter J Boström

PLoS One 2015 21;10(7):e0133552. Epub 2015 Jul 21.

Department of Urology, Turku University Hospital, Turku, Finland.

Inflammation is an important feature of carcinogenesis. Tumor-associated macrophages (TAMs) can be associated with either poor or improved prognosis, depending on their properties and polarization. Current knowledge of the prognostic significance of TAMs in bladder cancer is limited and was investigated in this study. We analyzed 184 urothelial bladder cancer patients undergoing transurethral resection of a bladder tumor or radical cystectomy. CD68 (pan-macrophage marker), MAC387 (polarized towards type 1 macrophages), and CLEVER-1/Stabilin-1 (type 2 macrophages and lymphatic/blood vessels) were detected immunohistochemically. The median follow-up time was 6.0 years. High macrophage counts associated with a higher pT category and grade. Among patients undergoing transurethral resection, all studied markers apart from CLEVER-1/Stabilin-1 were associated with increased risk of progression and poorer disease-specific and overall survival in univariate analyses. High levels of two macrophage markers (CD68/MAC387+/+ or CD68/CLEVER-1+/+ groups) had an independent prognostic role after transurethral resection in multivariate analyses. In the cystectomy cohort, MAC387, alone and in combination with CD68, was associated with poorer survival in univariate analyses, but none of the markers were independent predictors of outcome in multivariate analyses. In conclusion, this study demonstrates that macrophage phenotypes provide significant independent prognostic information, particularly in bladder cancers undergoing transurethral resection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133552PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511010PMC
May 2016

Concepts of capacity and performance in assessment of functioning amongst stroke survivors: A comparison of the Functional Independence Measure and the International Classification of Functioning, Disability and Health.

Authors:
Sinikka Tarvonen-Schröder Katri Laimi Tommi Kauko Mikhail Saltychev

J Rehabil Med 2015 Aug;47(7):662-4

Department of Rehabilitation and Brain Trauma, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland. E-mail:

Objective: To investigate the use of concepts of capacity and performance when assessing functioning of stroke survivors, measured with the Functional Independence Measure (FIM) and the International Classification of Functioning, Disability and Health (ICF).

Methods: During an inpatient interdisciplinary rehabilitation programme for 62 subacute stroke survivors, limitations in speaking, walking, toileting and eating were assessed at admission and discharge with both the FIM and a scale based on the ICF Brief Core Set for stroke. Correlation between the results obtained with these 2 scales was assessed using Spearman's correlation coefficient.

Results: The level of restriction of functioning, defined as capacity or performance in terms of the ICF, correlated well with the results obtained with the FIM (0.47-0.87) . The only statistically significant difference was found in assessing limitations in eating, where assessment with the FIM had a higher correlation with the concept of capacity than performance (0.75 vs 0.55). The observed correlations were not associated with stroke severity.

Conclusion: Even though the FIM and an ICF-based scale may describe limitation of functioning of stroke survivors similarly, ICF is probably more comprehensive in describing both capacity and performance.
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http://dx.doi.org/10.2340/16501977-1974DOI Listing
August 2015

Subtyping patients with temporomandibular disorders in a primary health care setting on the basis of the research diagnostic criteria for temporomandibular disorders axis II pain-related disability: a step toward tailored treatment planning?

Authors:
Ulla Kotiranta Tuija Suvinen Tommi Kauko Yrsa Le Bell Pentti Kemppainen Jorma Suni Heli Forssell

J Oral Facial Pain Headache 2015 ;29(2):126-34

Aims: To use the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II and additional pain-related and psychosocial variables to identify subtypes of TMD patients in a primary health care setting based on pain-related disability.

Methods: Consecutive TMD pain patients (n = 399) seeking treatment in a primary care setting completed a multidimensional pain questionnaire. Subtyping was based on the Graded Chronic Pain Scale (GCPS), and the patients were divided into a no-disability group (0 disability points), lowdisability group (1-2 disability points), and high-disability group (3-6 disability points). Psychosocial variables included RDC/TMD Axis II variables, anxiety, tension and stress, worry, catastrophizing, coping ability, general health, and other pain problems. Subtype differences were analyzed with t test, Wilcoxon rank-sum test, ANOVA, or Kruskal-Wallis test. A further analysis with multivariable logistic model was applied. All P values from pairwise comparisons were Bonferroni adjusted.

Results: Most (61%) of the patients belonged to the no-disability group, 27% to the low-disability group, and 12% to the high-disability group. When subtypes were compared, patients in the no-disability group appeared psychosocially well-functioning, with fewer symptoms related to psychosocial distress, better ability to control pain, and fewer jaw functional limitations and other pain problems. Patients in the high-disability group reported the highest levels of symptoms of depression and somatization, sleep dysfunction, worry, and catastrophizing thoughts. The low-disability patients formed an intermediate group between the no-disability and high-disability groups.

Conclusion: The results suggest that GCPS-related disability scoring can be used as a simple screening instrument in primary care settings to identify individuals with different, clinically relevant psychosocial subtypes.
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http://dx.doi.org/10.11607/ofph.1319DOI Listing
July 2015

Outcomes of cranioplasty with synthetic materials and autologous bone grafts.

Authors:
Jaakko M Piitulainen Tommi Kauko Kalle M J Aitasalo Ville Vuorinen Pekka K Vallittu Jussi P Posti

World Neurosurg 2015 May 11;83(5):708-14. Epub 2015 Feb 11.

Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.

Objective: Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications.

Methods: A retrospective review of the medical records of all patients who underwent cranioplasty for cranial bone defects during the period 2002-2012 was conducted, and 100 consecutive cranioplasty procedures that met eligibility criteria were identified. Patients were analyzed in 4 groups, which were created based on the cranioplasty material: autograft (n = 20), bioactive fiber-reinforced composite (n = 20), hydroxyapatite (n = 31), and other synthetic materials (n = 29). Survival estimates were constructed with Kaplan-Meier curves, and the differences between categorical variable levels were determined using a log-rank test. Multiple comparisons were adjusted using a Šidák correction.

Results: During a median follow-up time of 14 months (interquartile range 3-39 months), 32 of 100 patients (32.0%) developed at least 1 complication. A minor complication occurred in 13 patients (13.0%), whereas 19 patients (19.0%) developed a major complication, which required reoperation or removal of the implant. In the autograft subgroup, 40.0% of patients required removal of the cranioplasty. The 3-year survival of the autograft subgroup was lower compared with other subgroups of synthetic materials. In hydroxyapatite and bioactive fiber-reinforced composite groups, fewer complications were observed compared with the autograft group.

Conclusions: Based on these results, synthetic materials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.
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http://dx.doi.org/10.1016/j.wneu.2015.01.014DOI Listing
May 2015