Kuopio University Hospital

Kuopio, Finland

Kuopio University Hospital

Kuopio, Finland

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Three in four patients with refractory status epilepticus treated in an intensive care unit (ICU) are still alive a year later, and half of them have recovered to baseline function, according to a new study from the University of Eastern Finland. The study was the first to show the population-based incidences for refractory and super-refractory status epilepticus and to evaluate the long-term outcome. Anne-Mari Kantanen, MD, presented the results in her doctoral thesis at the University of Eastern Finland. "The thesis addresses an extremely important area of research, in which new treatment is now being developed which hopefully will have a significant impact on outcome in this serious condition," says Professor Simon Shorvon of University College London, who assessed the thesis as the opponent. Status epilepticus (SE), a prolonged seizure, is a neurological emergency that may cause death and marked neurological deficiency. If the first and second line medications fail to terminate the seizure, the condition is called refractory status epilepticus (RSE), and if it continues beyond 24 hours after the administration of first anaesthesia, it is called super-refractory status epilepticus (SRSE). Professor Shorvon was the first to define super-refractory status epilepticus in 2011 and could only estimate the incidence at the time. Data on long-term outcomes of SE remain scarce, particularly in the cases of RSE and SRSE, and are based on small patient cohorts. The present study was the first to analyse a population-based, nationwide cohort showing the incidence and long-term - one year - outcome of intensive care unit treated and anaesthesia treated RSE and SRSE. The Finnish Intensive Care Consortium (FICC) database and medical records were used to identify adult RSE patients treated in ICU with general anaesthesia in a population-based cohort in Finland during a 3-year period from 2010 to 2012. Altogether, there were 395 incidents of RSE, of which 87 (22%) were diagnosed as SRSE. The incidence of RSE was 3.4 per 100,000 persons per year, and 0.7 per 100,000 persons per year for SRSE. The one-year mortality of all RSE and SRSE patients was 25% and 36%, respectively. Super-refractoriness, dependence on others to perform activities of daily living functions, severity of organ dysfunction at ICU admission, and higher age predicted long-term mortality. The treatment outcome was studied in more detail in Kuopio University Hospital special responsibility area with a population of 840,000 people. Nearly 50% of the ICU-treated RSE patients recovered to baseline function, whereas 30% showed new functional defects, and 20% died. The outcome was worse in older patients and in patients with progressive or fatal aetiologies. In Finland, all patients with RSE and SRSE are treated in ICUs and the cases are comprehensively documented, which made the pioneering nationwide study possible. According to Dr Kantanen, starting treatment fast and administering first aid medication already before hospitalisation following the National Current Care Guidelines are vital to treatment outcome. "When paramedics start administering first aid medication quickly and the treatment continues in a hospital under the care of an on-call physician and a neurologist, the majority of epileptic seizures can be stopped and the excessive electrical activity in the brain normalises. It is vital to analyse the patient's clinical symptoms and to perform an emergency EEG to screen out patients who need to be quickly moved to an ICU in order to stop the seizure," Dr Kantanen concludes. The results were first published in Epilepsy & Behavior, Critical Care and Epilepsy Research. The doctoral dissertation, entitled Intensive Care Treated Refractory Status Epilepticus - Incidence and Outcome in Finland 2010-2012, is available for download at http://epublications. For further information, please contact: Anne-Mari Kantanen, tel. +358407270627, anne-mari.kantanen (a) kuh.fi


News Article | May 19, 2017
Site: www.scientificcomputing.com

The HumanTool project being led by VTT Technical Research Centre of Finland involves the testing of new indoor temperature control concepts for adjusting spaces to individual needs. Energy is saved when unused rooms can be left unheated or uncooled. The final result of the project will be a completely new product. We spend around 90% of our time indoors. Our experience of thermal sensation is important to productivity and comfort, and is mainly affected by a room's temperature level. The HumanTool project aims to enhance the comfort level of indoor temperatures, which affects the thermal comfort, health and well-being of a facility's users. Begun last autumn, the project will involve the practical testing and development of a smart temperature control concept in hospital and office conditions during two heating and cooling seasons. The first pilot sites will be VTT's main office, Digitalo, in Espoo, the Seinäjoki Central Hospital and Kuopio University Hospital. In the hospitals, testing will begin in office premises and then proceed to patient facilities. The experiences of various end-users of the rooms, such as staff and patients, will be gathered. "We will use the Human Thermal Model (HTM) method developed by VTT. We will evaluate the thermal sensations of various user groups, which will be taken into account in the design of comfortable and energy-efficient buildings. Because digital solutions for facility monitoring are now cost-efficient, we will use the latest technology for temperature control," says project manager Pekka Tuomaala of VTT. The results will be ready at the end of 2018 and can be applied in places such as offices, hospitals, hotels, schools and in vehicles. VTT is coordinating the HumanTool project, which began in October 2016. The project sponsors and partners are VTT, the Seinäjoki Central Hospital, Kuopio University Hospital, Senate Properties, Siemens, Uponor, Granlund, Mecastep and New Nordic Engineering.


News Article | May 19, 2017
Site: www.scientificcomputing.com

The HumanTool project being led by VTT Technical Research Centre of Finland involves the testing of new indoor temperature control concepts for adjusting spaces to individual needs. Energy is saved when unused rooms can be left unheated or uncooled. The final result of the project will be a completely new product. We spend around 90% of our time indoors. Our experience of thermal sensation is important to productivity and comfort, and is mainly affected by a room's temperature level. The HumanTool project aims to enhance the comfort level of indoor temperatures, which affects the thermal comfort, health and well-being of a facility's users. Begun last autumn, the project will involve the practical testing and development of a smart temperature control concept in hospital and office conditions during two heating and cooling seasons. The first pilot sites will be VTT's main office, Digitalo, in Espoo, the Seinäjoki Central Hospital and Kuopio University Hospital. In the hospitals, testing will begin in office premises and then proceed to patient facilities. The experiences of various end-users of the rooms, such as staff and patients, will be gathered. "We will use the Human Thermal Model (HTM) method developed by VTT. We will evaluate the thermal sensations of various user groups, which will be taken into account in the design of comfortable and energy-efficient buildings. Because digital solutions for facility monitoring are now cost-efficient, we will use the latest technology for temperature control," says project manager Pekka Tuomaala of VTT. The results will be ready at the end of 2018 and can be applied in places such as offices, hospitals, hotels, schools and in vehicles. VTT is coordinating the HumanTool project, which began in October 2016. The project sponsors and partners are VTT, the Seinäjoki Central Hospital, Kuopio University Hospital, Senate Properties, Siemens, Uponor, Granlund, Mecastep and New Nordic Engineering.


Kokki H.,Kuopio University Hospital
Paediatric Anaesthesia | Year: 2012

Summary Every anesthetist should have the expertise to perform lumbar puncture that is the prerequisite to induce spinal anesthesia. Spinal anesthesia is easy and effective technique: small amount of local anesthetic injected in the lumbar cerebrospinal fluid provides highly effective anesthesia, analgesia, and sympathetic and motor block in the lower part of the body. The main limitation of spinal anesthesia is a variable and relatively short duration of the block with a single-injection of local anesthetic. With appropriate use of adjuvant or combining spinal anesthesia with epidural anesthesia, the analgesic action can be controlled in case of early recovery of initial block or in patients with prolonged procedures. Contraindications are rare. Bleeding disorders and any major dysfunction in coagulation system are rare in children, but spinal anesthesia should not be used in children with local infection or increased intracranial pressure. Children with spinal anesthesia may develop the same adverse effects as has been reported in adults, but in contrast to adults, cardiovascular deterioration is uncommon in children even with high blocks. Most children having surgery with spinal anesthesia need sedation, and in these cases, close monitoring of sufficient respiratory function and protective airway reflexes is necessary. Postdural puncture headache and transient neurological symptoms have been reported also in pediatric patients, and thus, guardians should be provided instructions for follow-up and contact information if symptoms appear or persist after discharge. Epidural blood patch is effective treatment for prolonged, severe headache, and nonopioid analgesic is often sufficient for transient neurological symptoms. © 2011 Blackwell Publishing Ltd.


Riikonen R.S.,Kuopio University Hospital
European Journal of Paediatric Neurology | Year: 2010

The following aspects are reviewed: Does the aetiology influence the outcome of infantile spasms? Does the treatment influence the outcome? Can the outcome be predicted? Can we improve the prognosis? Favourable factors are the following: cryptogenic aetiology, age at onset ≥4 months, absence of atypical spasms and partial seizures, and absence of asymmetrical EEG abnormalities, short treatment lag, and an early and sustained response to treatment. Not only patients with a cryptogenic aetiology have a favourable outcome. We can already at the first clinical evaluation tell the parents if the prognosis looks favourable. The final goal of the treatment is improved mental outcome. Steroids and vigabatrin are the first-line drugs for infantile spasms in Europe. In a prospective study from the United Kingdom short-term outcome was better with hormonal than with vigabatrin therapy (tuberous sclerosis excluded). However, the numbers of patients who were seizure-free at 3-4 months in different studies have been very similar. Moreover, an early response to treatment seems to be of predictive value for the cognitive outcome in children with cryptogenic spasms. The long-term outcome is known only after hormonal therapy. The side effects of steroids are usually treatable and reversible. In Finland ACTH therapy is given at the minimum effective dose and for the minimum effective time with minimal side effects. The risks of VGB are irreversible visual field defects. As of yet there is no method to examine the visual fields in patients with infantile spasms. Early treatment of infantile spasms seems to be important. Prevention of infantile spasms with some aetiological groups might be possible. © 2009 European Paediatric Neurology Society.


Julkunen P.,Kuopio University Hospital
Journal of Neuroscience Methods | Year: 2014

Background: Navigated transcranial magnetic stimulation (nTMS) is used for locating and outlining cortical representation areas, e.g., of motor function and speech. At present there are no standard methods of measuring the size of the cortical representation areas mapped with nTMS. The aim was to compare four computation methods for estimating muscle representation size and location for nTMS studies. New method: The motor cortex of six subjects was mapped to outline the motor cortical representation of hand muscles. Four methods were compared to assess cortical representation size in nTMS. These methods included: (1) spline interpolation method, (2) convex hull method, which outlines all positive motor responses, (3) Voronoi tessellation method, which assigns a specific cortical area for each stimulus location, and (4) average point-area method, which computes an average representation area for each stimulus with the assumption of evenly spaced stimulus locations, i.e., the use of a grid. Results: All applied methods demonstrated good repeatability in measuring muscle representation size and location, while the spline interpolation and the convex hull method demonstrated systematically larger representation areas (p< 0.05) as compared to the average point-area method. Spline interpolation method demonstrated the best repeatability in location. Comparison with existing methods: Unlike the previous methods, the presented methods can be applied for the estimation of the representation area of nTMS-induced activation without the use of an evenly spaced stimulus grid. Conclusions: The spline interpolation method and the Voronoi tessellation method could be used for evaluating motor cortical muscle representation size and location with nTMS, e.g., to study cortical plasticity. © 2014 Elsevier B.V.


Jouppila-Matto A.,Kuopio University Hospital
BMC cancer | Year: 2011

Epithelial-mesenchymal transition (EMT) is a crucial process in tumorigenesis since tumor cells attain fibroblast-like features enabling them to invade to surrounding tissue. Two transcription factors, TWIST and SNAI1, are fundamental in regulating EMT. Immunohistochemistry was used to study the expression of TWIST and SNAI1 in 109 pharyngeal squamous cell carcinomas. Tumors with intense stromal staining of TWIST relapsed more frequently (p = 0.04). Tumors with both positive TWIST and SNAI1 immunoreactivity in the stroma were at least Stage II (p = 0.05) and located more often in hypopharynx (p = 0.035). Tumors with negative immunostaining of TWIST and SNAI1 in the stromal compartment were smaller (T1-2) (p = 0.008), less advanced (SI-II) (p = 0.031) and located more often in the oropharynx (p = 0.007). Patients with negative SNAI1 and TWIST immunostaining in tumor stroma had a better 5-year disease-specific and overall survival (p = 0.037 and p = 0.014 respectively). TWIST and SNAI1 expression in stromal cells is associated with clinical and histopathological characteristics that indicate progressive disease. Negative expression of these EMT-promoting transcription factors predicts a better outcome.


Enteropathy-associated T-cell lymphoma (EATL) is a rare subtype of peripheral T-cell lymphomas with a poor prognosis. Autologous stem cell transplantation (ASCT) was retrospectively evaluated as a consolidation or salvage strategy for EATL. The analysis included 44 patients who received ASCT for EATL between 2000 and 2010. Thirty-one patients (70%) were in first complete or partial remission at the time of the ASCT. With a median follow-up of 46 months, relapse incidence, progression-free survival, and overall survival were 39%, 54%, and 59% at 4 years, respectively, with only one relapse occurring beyond 18 months posttransplant. There was a trend for better survival in patients transplanted in first complete or partial remission at 4 years (66% vs 36%; P = .062). ASCT is feasible in selected patients with EATL and can yield durable disease control in a significant proportion of the patients.


Laakso M.,Kuopio University Hospital | Kuusisto J.,Kuopio University Hospital
Nature Reviews Endocrinology | Year: 2014

The prevalence of diabetes mellitus will likely increase globally from 371 million individuals in 2013 to 552 million individuals in 2030. This epidemic is mainly attributable to type 2 diabetes mellitus (T2DM), which represents about 90-95% of all cases. Cardiovascular disease is the leading cause of mortality among individuals with diabetes mellitus, and >50% of patients will die from a cardiovascular event - especially coronary artery disease, but also stroke and peripheral vascular disease. Classic risk factors such as elevated levels of LDL cholesterol and blood pressure, as well as smoking, are risk factors for adverse cardiovascular events in patients with type 1 diabetes mellitus (T1DM) and T2DM to a similar degree as they are in healthy individuals. Patients with T1DM develop insulin resistance in the months after diabetes mellitus diagnosis, and patients with T2DM typically develop insulin resistance before hyperglycaemia occurs. Insulin resistance and hyperglycaemia, in turn, further increase the risk of adverse cardiovascular events. This Review discusses the mechanisms by which T1DM and T2DM can lead to cardiovascular disease and how these relate to the risk factors for coronary artery disease. © 2014 Macmillan Publishers Limited.


Kuusisto J.,Kuopio University Hospital
Current cardiology reports | Year: 2013

Type 2 diabetes increases the risk of cardiovascular disease (CVD) from two- to four-fold. In our large Finnish population-based study published in 1998 subjects with medication for type 2 diabetes had as high a risk of fatal and nonfatal myocardial infarction (MI) during the 7- year follow-up as non-diabetic subjects with a prior MI, suggesting that type 2 diabetes is a CVD equivalent. In another large study, including all 3.3 million residents of Denmark, subjects requiring glucose-lowering therapy exhibited a CVD risk similar to that of non-diabetic subjects with a prior MI. Subsequent studies have not systematically replicated aforementioned results. Some studies have supported the concept that type 2 diabetes is a CVD equivalent only in some subgroups, and many studies have reported negative findings. This is likely to be due to many differences across the studies published, for example ethnicity, gender, age and other demographic factors of the populations involved, study design, validation of diabetes status and CVD events, statistical analyses (adjustments for confounding factors), duration of diabetes, and treatment of hyperglycemia among diabetic participants. Varying results reflect the fact that not all diabetic patients are at a similar risk for CVD. Therefore, CVD risk assessment and the tailoring of preventive measures should be done individually, taking into consideration each patient's long-term risk of developing cardiovascular events.

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