Kymenlaakson keskussairaala

Harmonization of neuropsychological assessment for vascular cognitive impairment and dementia (VCID) is important for ensuring the highest standards and consistency of diagnosis. A battery proposed in 2006 by the National Institute for Neurological Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) has received much international support. Considering significant advances in the field, including the rise of computerized and remote assessment methods, a revision is needed. To develop an updated harmonized battery and associated assessment guidelines for VCID. NINDS-CSN and other relevant published harmonized neuropsychological batteries, aided by literature review of recent developments in VCID, were used as reference points for an online Delphi survey (≥3 rounds, ≥75% threshold for agreement), including questions on a core test battery based on key cognitive domains that should be assessed for VCID, consideration of computerized and remote assessment methods, and assessment of diverse populations. International experts in neuropsychological assessment from diverse international regions were invited to participate in 2023. Data were analyzed from October 11, 2023, to June 20, 2024. A total of 44 experts participated in 3 survey rounds, with 28 to 31 participants each. Consensus was reached on a core assessment battery of neuropsychological tests based on key cognitive domains, and additional guidelines for a more comprehensive test battery, cognitive screening, telehealth and computerized assessment methods, principles for normative standardization, and the assessment of diverse populations. The key cognitive domains were harmonized with the International Society for Vascular Behavioural and Cognitive Disorders version 2 World Stroke Organization (VasCog-2-WSO) diagnostic criteria for VCID. This consensus statement describes the development of a harmonized neuropsychological assessment battery and guidelines for VCID (VasCog-NP) that expands on the NINDS-CSN battery with more comprehensive and flexible assessment of VCID. Harmonized with the VasCog-2-WSO diagnostic criteria, VasCog-NP could be adopted internationally to further help more consistent neuropsychological evaluations related to VCID, facilitating global comparisons for clinicians and researchers.

Mechanical forces of the tumor microenvironment change dynamically during key events of tumorigenesis such as invasion and metastasis. These changes in compressive forces often affect the breast cancer cell phenotype. However, it is lesser known how these dynamic mechanical forces in the tumor microenvironment affect the phenotypes of tumor infiltrated leukocytes (TIL) and their subsequent anticancer activities. Here we find, in primary patient-derived explant cultures (PDEC) containing resident TILs, that low compression promotes a change in the original identity of breast cancer cells from luminal to a more mesenchymal and undifferentiated state. These altered tumor cells induce an upregulation of immunosuppressive cytokines such as interleukin-10 (IL-10) and Transforming Growth Factor Beta (TGF-β), as well as polarization of macrophages towards pro-tumor M2(Gc)-type and depletion of CD8+ effector memory T-cells. These immunosuppressive events are mediated by tumor cell derived fibroblast growth factor 2 (FGF2) and prostaglandin E2 (PGE2). We also find that FGF2 rich areas in primary tumors show enrichment in M2-like-macrophages and diminished numbers of CD8 + T and B-cells. Our results suggest that low compressive forces in the tumor microenvironment induce local immunosuppression via FGF2 secretion arising from phenotypic plasticity of tumor cells.

To investigate the potential progression rate of cerebral small vessel disease (CSVD) in brain MRI among neurologically asymptomatic middle-aged individuals with type 1 diabetes. A total of 172 individuals with type 1 diabetes were re-examined with brain MRI 7.5 years after their initial visit. Baseline predictors of changes in CSVD, particularly cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs) were analyzed. The proportion of individuals with type 1 diabetes with CSVD increased from 36% to 70% (P < 0.001), CMBs increased from 17% to 33% (P < 0.001), and WMHs from 23% to 63% (P < 0.001) at follow-up. The increase in CMBs was associated with baseline systolic blood pressure, HbA1c, and preexisting CMBs. The increases in CSVD and WMHs were associated only with age. The prevalence of CSVD doubled over a 7.5-year period in middle-aged individuals with type 1 diabetes.

To evaluate the complication rates of different intraocular lens (IOL) placement methods in adults with inadequate capsular bag support. The surgical correction of inadequate capsular bag support for the IOL harbors several challenges, and there is a wide range of surgical procedures. For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (1) anterior chamber (AC) placement; (2) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL; and (3) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of 2 or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557). 15 studies were included in the final analysis, which reported results of 1247 eyes. The overall complication rate was nonsignificantly lower in iris fixation (4.4%; 95% CI, 3.6%-5.4%, P = .150) than in AC placement (7.4%; 95% CI, 6.4%-7.9%) and scleral fixation (7.4%; 95% CI, 6.5%-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95% CI, 2.4%-57.5%, P < .001), compared with scleral fixation (11.9%; 95% CI, 2.6%-21.2%) and iris fixation (4.1%; 95% CI, 0.8%-7.3%). Vitreous hemorrhages were more frequently reported after scleral fixation (8.5%; 95% CI, 6.3%-11.2%, P = .006) than in AC placement (5.4%; 95% CI, 3.4%-8.5%) and iris fixation (1.4%; 95% CI, 0.4%-4.2%), and so was IOL decentration/dislocation (8.9%; 95% CI, 6.7%-11.8%, P = .047 compared with 1.1%; 95% CI, 0.4%-3.4% and 4.0%; 95% CI, 2.2%-7.3%, respectively). The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.

PurposeHere we examine the association of anti‐inflammatory therapy with anatomical and functional outcomes of epiretinal membrane surgery.MethodsThe study included consecutive patients having gone through epiretinal membrane surgery at Helsinki University Hospital, Finland, between 2017 and 2021. The association of perioperative intravitreal and postoperative topical anti‐inflammatory therapies with surgical outcomes was assessed.ResultsIn total, 214 eyes of 214 patients with a mean age of 71.2 ± 8.2 years were studied. At 1‐month, perioperative intravitreal use of triamcinolone acetonide (n = 27) was associated with a significant proportional and absolute improvement in foveal thickness (−15.9 ± 18.4% vs. −4.2 ± 25.6%, p = 0.003 and −86.2 ± 109.6 μm vs. −33.7 ± 94.3 μm, p = 0.004), and central subfield macular thickness (−14.7 ± 16.5% vs. −6.3 ± 16.9%, p = 0.009 and −80.6 ± 102.8 μm vs. −36.1 ± 75.9 μm, p = 0.004) when compared to those without triamcinolone acetonide. Furthermore, best‐corrected visual acuity (BCVA) gain showed a non‐significant yet corresponding trend favouring intraoperative intravitreal use of triamcinolone acetonide (0.21 ± 0.27 vs. 0.09 ± 0.28 LogMAR units, p = 0.062). Postoperative use of topical non‐steroidal anti‐inflammatory drugs (NSAIDs) (n = 36) as adjunct therapy showed no significant advantage in anatomical outcomes or BCVA gain when compared to those without NSAIDs (all p > 0.05). Triamcinolone acetonide remained significant for proportional and absolute improvement in foveal thickness (p = 0.019 and p = 0.006) and in central subfield macular thickness (p = 0.013 and p = 0.006) when controlled for confounding factors patient age and gender and topical NSAID use.ConclusionsIntraoperative intravitreal use of triamcinolone acetonide improved short‐term anatomical outcomes in patients who underwent epiretinal membrane surgery.

The prevalence of chronic kidney disease (CKD) is increasing and CKD often goes undiagnosed and untreated until its later stages when irreversible damage has occurred. Patients with CKD have been reported to have lower quality of life than the general population, but the patient-reported outcome data on CKD patients in Finland are limited. The primary outcome of this structural, multiple-choice survey study was to assess life satisfaction and experienced health status in Finnish patients with CKD. The results were presented as numbers (n) and percentages (%). The secondary outcome was to identify patient groups using the K-means clustering method based on preselected response variables and to assess the associated background factors. In total, 558 patients with CKD responded to the electronic survey. Of the 395 patients who completed the whole survey, 39.7% reported their health status as good, pretty good, or excellent, and 59.9% were fairly or very satisfied with their life. Two clusters of patients could be identified based on their health status and life satisfaction: patients with (1) poorer or (2) better well-being. Patients with poorer well-being were more likely to have at least 3 comorbidities (66.8% vs 44.3%) and lack follow-up visits entirely (10.5% vs 1.9%), compared with patients with better well-being. The patients with poorer well-being were less often knowledgeable about the disease, its causes (35.5% vs 48.1%), and its care (30.7% vs 20.3%) than patients with better well-being, and they showed weaker adherence to lifestyle interventions such as following dietary instructions (30.3% vs 40.5%). Screening for CKD to enable early diagnosis, early commitment to treatment, and empowering the patient by providing education are key for improvement of health and life satisfaction in patients with CKD. Therefore, resources should be allocated to these measures of action.

Childhood risk factors are associated with cardiovascular events in adulthood. We compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a model that additionally included lipids to predict cardiovascular events in adulthood. The study comprised 11 550 participants from 7 longitudinal cohort studies in the United States, Australia, and Finland with risk factor measurements in adolescence and followed into adulthood. The adolescent risk factors were defined by using clinical standards including overweight or obesity, elevated blood pressure, smoking, and borderline high or high levels of total cholesterol and triglycerides. The main outcomes were medically adjudicated fatal or nonfatal cardiovascular disease events occurring after age 25. Of 11 550 participants (55.1% female, mean age 50.0 ± 7.7 years), 513 (4.4%) had confirmed cardiovascular events. In a multivariable model (hazard ratio [95% confidence interval]), elevated blood pressure (1.25 [1.03-1.52]), overweight (1.76 [1.42-2.18]), obesity (2.19 [1.62-2.98]), smoking (1.63 [1.37-1.95]), and high total cholesterol (1.79 [1.39-2.31]) were predictors of cardiovascular events (P < .05). The addition of lipids (total cholesterol and triglycerides) into the nonlaboratory model (age, sex, blood pressure, BMI, and smoking) did not improve discrimination in predicting cardiovascular events (C-statistics for the lipid model 0.75 [SD 0.07] and nonlaboratory model 0.75 [0.07], P = .82). Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted adult cardiovascular events. The addition of lipid measurements to nonlaboratory risk factors did not improve the prediction of cardiovascular events.