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Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.

Urologisista syövistä munuaissyöpä on kolmanneksi yleisin ja huonoennusteisin. Suomessa todetaan vuosittain noin 900–1000 uutta munuaissyöpätapausta, joista noin 8,5 % todetaan alle 50-vuotiailta. Munuaissyövän tärkein ja ainoa kuratiivinen hoito on leikkaus, jossa poistetaan joko kokonaan toinen munuainen tai vain osa munuaisesta. Tunnettuja munuaissyövän riskitekijöitä ovat tupakointi, lihavuus ja korkea verenpaine. Nuoren iän on todettu olevan ennustetta parantava tekijä. Tämän työn tarkoituksena on verrata nuorten (alle 50 v) munuaissyöpäpotilaiden etiologiaa, leikkaushoidon tuloksia ja ennustetta ≥ 50-vuotiaisiin potilaisiin. Tutkimusaineistoon sisältyi Tampereen yliopistollisessa sairaalassa (TAYS) vuosina 1998–2017 diagnosoidut ja leikkaushoidetut munuaissyöpäpotilaat. Tutkimus on retrospektiivinen ja aineisto kerättiin TAYS:n potilastietokannasta. Tapaukset, joissa ei ollut tietoa leikkauksesta, kasvaimen histologiasta tai 1, 5 tai 10 vuoden elossaolosta, suljettiin pois. Lopulliseen analyysiin sisältyi 474 tapausta. Näistä 50 tapausta oli alle 50-vuotiaita ja 424 tapausta oli 50-vuotiaita tai vanhempia. Näitä kahta ryhmää vertailtiin keskenään. Potilasryhmien välillä kliinisesti merkitseviä eroja oli sukupuolijakaumassa, tupakointistatuksessa ja ASA-luokassa. Nuoremmassa ryhmässä oli enemmän miehiä suhteessa naisiin, suurempi osa tupakoi diagnoosihetkellä ja ASA-luokka oli matalampi. Painoindeksissä, sairastavuudessa tai siinä, oliko potilaalla oireita diagnoosihetkellä ei todettu tilastollisesti merkitsevää eroa ryhmien välillä. Alle 50-vuotiailla kasvain oli keskimäärin pienempi ja pT-luokka matalampi kuin ≥ 50-vuotiailla. Leikkauksen aikaisissa komplikaatioissa, leikkausvuodon määrässä tai leikkauksesta toipumisessa ei ollut merkitsevää eroa ryhmien välillä. Nuoremmasta ryhmästä 62 % oli elossa viiden vuoden jälkeen leikkauksesta ja 58 % oli elossa vielä 10 vuoden jälkeen leikkauksesta. Vastaavat luvut iäkkäämmässä ryhmässä olivat 46,7 % ja 32,3 %. Edellä esitetyt tulokset ovat samansuuntaisia aiempien tutkimustulosten kanssa ja vahvistavat niitä. Tutkimuksen vahvuutena oli pitkä seuranta-aika ja heikkoutena retrospektiivinen tutkimusasetelma. Jatkossa vastaavanlaista tutkimusta lääkehoidetuista potilaista tarvitaan. Lisäksi termoablaatiohoidon tulosten vertaaminen leikkaushoidon tuloksiin nuorilla potilailla on tarpeen. Tulevaisuudessa myös elintapojen, kuten ruokavalion ja liikunnan määrän, vaikutusta munuaissyövän riskiin ja ennusteeseen on syytä tutkia.

ObjectivesTo investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol.MethodsIn this non-blinded randomised controlled trial, 52 individuals aged 60–75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee.ResultsImprovement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by −1.9 s (95% CI, −2.9 to −1.0), while it changed by −0.6 s (95% CI −1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee.ConclusionIn patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful.Trial registration numberNCT03717727.

Tutkimuksen tavoitteena oli selvittää kahden eri leikkausmenetelmän vaikutusta hoitotulokseen reumapäkiän hoidossa. Hyödynnettävät leikkaustavat olivat Weilin osteotomia ja caput-resektio, kumpaankin ryhmään satunnaistettiin kuusi potilasta. Potilaiden tilaa seurattiin preoperatiivisesti, sekä 12 ja 24 kk kontrolleilla FFI- ja AOFAS-kyselyiden avulla. Tulosten ryhmien väliltä ei löytynyt merkitsevää eroa, vaikka kaikilla potilailla tulokset paranivat leikkausta edeltäneeseen tilanteeseen. Tutkimustulosten tulkintaa vaikeuttaa potilasmäärän vähäisyys sekä useat puuttuvat testitulokset. Lisätutkimusta vaaditaan.

Background: Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). Objective: This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. Methods: This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients’ perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. Results: This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. Conclusions: Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. Trial Registration: ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727 International Registered Report Identifier (IRRID): RR1-10.2196/38434 publishedVersion

Study Design. Retrospective additional analysis of a prospective follow-up study. Objectives. We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease. Summary of Background Data. Revisions for ASD accumulate over time after LSF for degenerative lumbar spine disease. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial. Materials and Methods. A total of 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Preoperative and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models. Results. We did not find the poor postoperative balance [pelvic incidence-lumbar lordosis (LL) >9°] to significantly increase the risk of revisions for ASD: crude hazard ratio (HR)=1.5 [95% confidence interval (CI): 0.8-2.7], adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion): HR=1.7 (95% CI: 0.9-3.3). We found higher LL outside the fusion segment (LL-segmental lordosis) to decrease the risk of revisions for ASD: HR=0.9 (95% CI: 0.9-1.0). Conclusion. Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility. publishedVersion

Background: Patient-reported outcomes (PROS) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Objective: We aim to compare the rate of revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) surgery between patients with isthmic spondylolisthesis (IS) and degenerative lumbar spine disorders (DLSD). Summary of Background Data: ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods: 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n=64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n=222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n=79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. Results: Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6 to 22.1%); 2) 20.5% (95% CI: 15.6 to 26.7%); 3) 20.6% (95% CI: 12.9 to 31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10 to 13.96), p=0.035], [3) HR (95% CI) of 4.27 (1.11 to 15.54), p=0.036]. Conclusions: Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD. peerReviewed

Background Outcomes after metastasectomy for metastatic colorectal cancer (mCRC) vary with RAS and BRAF mutational status, but their effects on resectability and conversion rates have not been extensively studied. Methods This substudy of the prospective RAXO trial included 906 patients recruited between 2011 and 2018. We evaluated repeated centralised resectability assessment, conversion/resection rates and overall survival (OS), according to RAS and BRAF status. Results Patients included 289 with RAS and BRAF wild-type (RAS and BRAFwt), 529 with RAS mutated (RASmt) and 88 with BRAF mutated (BRAFmt) mCRC. Metastatic prevalence varied between the RAS and BRAFwt/RASmt/BRAFmt groups, for liver (78%/74%/61%), lung (24%/35%/28%) and peritoneal (15%/15%/32%) metastases, respectively. Upfront resectability (32%/29%/15%), conversion (16%/13%/7%) and resection/local ablative therapy (LAT) rates (45%/37%/17%) varied for RASa and BRAFwt/RASmt/BRAFmt, respectively. Median OS for patients treated with resection/LAT (n = 342) was 83/69/30 months, with 5-year OS-rates of 67%/60%/24%, while systemic therapy-only patients (n = 564) had OS of 29/21/15 months with 5-year OS-rates of 11%/6%/2% in RAS and BRAFwt/RASmt/BRAFmt, respectively. Resection/LAT was associated with improved OS in all subgroups. Conclusions There were significant differences in resectability, conversion and resection/LAT rates according to RAS and BRAF status. OS was also significantly longer for RAS and BRAFwt versus either mutant. Patients only receiving systemic therapy had poorer long-term survival, with variation according to molecular status. Clinical trial registration NCT01531621/EudraCT2011-003158-24

Rintalastan avausta eli sternotomiaa käytetään sydämen ja muissa rintaontelon leikkauksissa. Tässä tutkimuksessa tutkittiin komplikaatioiden esiintymistä viiden vuoden aikana sternotomialeikkauksen jälkeen. Potilaat jaettiin iän, sukupuolen, tupakoinnin ja painoindeksin mukaisesti ryhmiin ja ryhmien välillä vertailtiin komplikaatioiden lukumäärää, vaikeimman komplikaation vaikeusastetta, sekä laskettiin riskisuhde vähintään yhden komplikaation esiintymiselle. Kaikille potilaille oli tehty sydämen ohitusleikkaus ja he olivat osallistuneet Pitkittynyt postoperatiivinen kipu ohitusleikatuilla potilailla -tutkimukseen. Alkuperäinen aineisto oli kerätty ohitusleikkausten jälkeen. Tuolloin arvioitiin pitkittynyttä kipua, lisäksi potilaille teetettiin myös masennus- ja ahdistuneisuuskyselyt. Tässä tutkimuksessa alkuperäistä aineistoa täydennettiin keräämällä potilaskertomusjärjestelmästä potilaiden tiedoista leikkausten jälkeen esiintyneet komplikaatiot ja niiden luokka. Komplikaatioiden vaikeusaste määritettiin Clavien-Dindo-luokituksella. Aineiston 99 potilaasta 41:llä esiintyi ainakin yksi postoperatiivinen komplikaatio. Yleisin komplikaatio oli eteisvärinä. Joitain viitteitä saatiin siitä, että naisilla, tupakoinnin lopettaneilla, yli 69-vuotiailla ja painoindeksiltään 30 tai yli esiintyisi hieman todennäköisemmin jokin komplikaatio kuin vertailuryhmällä. Naisilla komplikaatioiden lukumäärän mediaani oli hieman suurempi kuin miehillä. Erot ryhmien välillä eivät kuitenkaan olleet tilastollisesti merkitseviä. Komplikaatioiden vaikeusasteessa eroa sukupuolten välillä ei ollut.

Publisher Copyright: © 2021 The Authors A B S T R A C T Background: The Foot and Ankle Outcome Score (FAOS) is one of the most frequently used patient reported outcome measures for foot and ankle conditions. The aim is to test the structural validity of the Finnish version of the FAOS using Rasch Measurement Theory. Methods: FAOS scores were obtained from 218 consecutive patients who received operative treatment for foot and ankle conditions. The FAOS data were fitted into the Rasch model and person separation index (PSI) calculated. Results: All the five subscales provided good coverage and targeting. Three subscales presented unidimensional structure. Thirty-eight of the 42 items had ordered response category thresholds. Three of the 42 items had differential item functioning towards gender. All subscales showed sufficient fit to the Rasch model. PSI ranged from 0.73 to 0.94 for the subscales. Conclusions: The Finnish version of the FAOS shows acceptable structural validity for assessing complaints in orthopaedic foot and ankle patients. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of European Foot and Ankle Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.

Study Design: Prospective follow-up study. Objectives: We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. Methods: 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. Results: The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was −26 (95% CI: −24 to −28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. Conclusions: Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population. peerReviewed

JOHDANTO Munuaissyövän insidenssi on kasvussa ja suuri osa munuaiskasvaimista todetaan sattumalöydöksenä vatsan kuvantamisen (ultraääni tai tietokonetomografia) yhteydessä. Munuaissyövän parantava hoito on leikkaushoito, nefrektomia tai munuaisen osapoisto, resektio. Pienten (≤ 4 cm) munuaistuumoreiden kasvutaipumus on usein hidas, joten kasvainta voidaan jäädä seuraamaan ja kirurgiseen hoitoon edetä, jos kasvutaipumusta todetaan. Iäkkäillä leikkauskelpoisuus on usein nuoria potilaita huonompi ja eliniänodote lyhyempi, eikä pieni munuaiskasvain hoitamattomanakaan välttämättä ehdi vaikuttaa potilaan kokonaisennusteeseen. Työn tarkoituksena on vertailla ≥ 75-vuotiaiden pienten munuaissyöpäkasvainten hoidon tuloksia ja siihen vaikuttavia tekijöitä

Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.

Johdanto Munuaissyöpä kattaa lähes 3 % kaikista syövistä, kirkassolukarsinooman (RCC) esiintyvyys on viime vuosina ollut nousussa. Useimmat ovat oireettomia pitkään ja suurin osa munuaissyöpätapauksista löytyy sattumalta. Tämän työn tarkoituksena on vertailla munuaissyövän kirurgisia hoitotuloksia vuosien 2000–2002 sekä 2015–2017 välillä. Aineisto ja menetelmät Kyseessä on retrospektiivinen rekisteritutkimus, jonka aineisto on kerätty Tays:ssa vuosina 2000–2002 sekä 2015–2017 leikattujen munuaissyöpäpotilaiden potilasasiakirjamerkinnöistä. Identifioimme ICD-koodilla C64.88 diagnosoidut munuaissyöpäpotilaat. Lisäksi haimme potilaita erilaisilla toimenpidekoodeilla. Aineistoksi saimme 116 vuosina 2000–2002 ja 128 vuosina 2015–2017 leikattua potilasta. Tulokset Vuosina 2000–2002 potilaiden keski-ikä munuaissyövän diagnoosihetkellä oli 66,2 vuotta, vuosina 2015–2015 66,6 vuotta. Suurimmalla osalla todettiin paikallinen solidi syöpä, metastasoitunut syöpä havaittiin vuosina 2000–2002 27,6 %:lla ja vuosina 2015–2015 23,4 %:lla potilaista. Vuosina 2000–2002 kaikille potilaille suoritettiin avoin leikkaus, joko transabdominaalisesti (90,5 %) tai retroperitoneaalisesti (9,5 %). Vuosina 2015–2017 käytettiin avoimen leikkauksen lisäksi myös laparoskooppista leikkausta; avoimesti leikattiin 36,7 % potilaista, laparoskooppisesti 63,3 %. Leikkausvuodon määrä oli merkittävästi vähäisempi 2015-2017 (200 ml vs 650 ml (p < 0,05)). Verensiirtoja suoritettiin leikkauksen aikana vuosina 2000-2002 50,0 %:lle potilaista, vuosina 2015-2017 vastaava luku oli 11,7 %, (p

Background: The structural validity of the Lower extremity functional scale (LEFS), the Visual analogue scale foot and ankle (VAS-FA), and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) has not been compared earlier in patients after foot and ankle surgery. Methods: Altogether 165 previously operated patients completed the foot and ankle specific instruments, the 15D health-related quality of life (HRQoL) instrument, and general health (VAS). Results: The LEFS, the VAS-FA and the WOMAC had slight differences in their measurement properties. The VAS-FA had the best targeting and coverage. All three foot and ankle measures accounted for mobility and usual activities when compared to the different aspects of generic HRQoL. Conclusions: The LEFS, the VAS-FA and the WOMAC have relatively similar psychometric properties among foot and ankle patients, yet the VAS-FA provides the best targeting and coverage. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Objective: To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. Design: Randomized controlled trial. Setting: Outpatient physical and rehabilitation medicine clinic. Subjects: Forty-five patients (mean age: 35 years; standard deviation (SD): 10 years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). Intervention: The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. Main measures: Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. Results: No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10–23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7–19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. Conclusion: Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.

Background: The Boston Carpal Tunnel Questionnaire (BCTQ) and its shorter version, the Six-Item Carpal Tunnel Symptoms Scale (CTS-6), are widely used for assessing function and/or symptoms in patients with carpal tunnel syndrome. This study examined the structural validity of the BCTQ and CTS-6 among patients who had undergone surgery for treatment of carpal tunnel syndrome. Methods: The data for this cross-sectional analysis were obtained from 217 adult patients who had undergone carpal tunnel release surgery one year earlier. All patients completed the CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ at 12 months after surgery. The Rasch Measurement Theory (RMT) was applied to investigate the unidimensionality, residual correlation, differential item functioning, scale coverage/targeting, and person separation of the CTS-6, SSS and FSS of the BCTQ.Results: The FSS showed unidimensionality and good scale and item fit. All items showed ordered response category thresholds. Eight of the FSS items displayed differential item functioning favoring age or gender. The multidimensional structure of the CTS-6 was absorbed by creating a testlet for frequency of symptoms or testlets for pain and numbness. The testlets supported unidimensionality in the BCTQ SSS. One item in the CTS-6 and two items in the BCTQ SSS showed differential item functioning favoring age or gender. Four items in the BCTQ SSS and two items in the CTS-6 exhibited disordered response category thresholds. Merging of the relevant response categories led to ordered response category thresholds. The person separation indices were 0.73, 0.86 and 0.77 for the CTS-6, BCTQ SSS and FSS, respectively.Conclusions: Based on the RMT analysis, the CTS-6 has superior psychometric properties compared to the BCTQ SSS in surgically treated patients. The CTS-6 might be more accurate when separated into item sets measuring pain or numbness. The FSS of the BCTQ has acceptable construct validity, although gender differences at some ages were observed in responses.

Introduction: The construct validity of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) has previously been questioned. The purpose of this study was to evaluate the measurement properties of the Finnish version of the DASH for assessing disability in patients with hand complaints using Rasch Measurement Theory. Methods: A cohort of 193 patients with typical hand and wrist complaints were recruited at a surgery outpatient clinic. The DASH scores were analysed using the Rasch model for differential item functioning, unidimensionality, fit statistics, item residual correlation, coverage/targeting and reliability. Results: In the original DASH questionnaire, the item response thresholds were disordered for 2 of 30 of the items. The item fit was poor for 9 of 30 of the items. Unidimensionality was not supported. There was substantial residual correlation between 87 pairs of items. Item reduction (chi square 95, degrees of freedom 50, p

Study Design. A prospective cohort study. Objective. This study evaluated the cumulative reoperation rate and indications for reoperation following instrumented lumbar spine fusion (LSF). Summary of Background Data. LSF reduces disability and improves health-related quality of life for patients with several spinal disorders. The rate of instrumented LSF has drastically increased over the last few decades. The increased incidence of LSF, however, has led to increased reoperation rates. Methods. The data are based on the prospective LSF database of Tampere University Hospital that includes all elective indications for LSF surgery. A total of 433 consecutive patients (64% women, mean age 62 years) who underwent LSF in Tampere University Hospital between 2008 and 2011 were evaluated and indications for reoperations were rechecked from patient records and radiographs. The most common diagnosis for the primary surgery was degenerative spondylolisthesis and the mean follow-up time was 3.9 years. The cumulative incidence of reoperations and the ‘‘time to event’’ survival rate was calculated by Kaplan-Meier analysis. Results. By the end of 2013, 81 patients had undergone at least one reoperation. The cumulative reoperation rate at 2 years was 12.5% (95% confidence interval: 95% CI: 9.7–16.0) and at 4 years was 19.3% (95% CI: 15.6–23.8). The most common pathology leading to reoperation was adjacent segment pathology with a cumulative reoperation rate of 8.7% (95% CI: 6.1–12.5) at 4 years. The corresponding rates for early and late instrumentation failure were 4.4% (95% CI: 2.7–7.0) and 2.9% (95% CI: 1.9–7.1), respectively, and for acute complications, 2.5% (95% CI: 1.4–4.5). Conclusion. Although previous studies reported that early results of spinal fusion are promising, one in five patients required reoperation within 4 years after surgery. Patients and surgeons should be aware of the reoperation rates when planning fusion surgery. Key words: adjacent segment, complications, instrumented lumbar spine fusion, pathology, reoperation. Level of Evidence: 4 Spine 2018;43:295–301 peerReviewed

Purpose: Interleukin 6 (IL-6) and the acute phase C-reactive protein (CRP) blood concentrations after lumbar spine fusion may be affected by age. The purpose of this prospective observational study was to assess postoperative serum levels of pro-inflammatory IL-6 and CRP after instrumented lumbar spine fusion surgery. We hypothesized that older patients would have increased levels of IL-6 and CRP after surgery. Methods: IL-6 and high-sensitive CRP biochemical marker levels were measured before instrumented spinal fusion, and postoperatively at 1 and 3 days, 6 weeks, and 3 months. The 49 patients in this sample were divided into two groups: age ≤ 60 years (n = 23) and age > 60 years (n = 26). Results: Acute changes in IL-6 high-sensitivity and CRP from preoperative levels to postoperative day (POD) 1 increased with age. Mean (95% CI) difference between the age-groups in changes of IL-6 at PODs 1 and 3 was 45 pg/ml (10–83, p = 0.014) and 20 pg/ml (5–36, p = 0.021), respectively. Mean (95% CI) difference between groups in changes of CRP at PODs 1 and 3 was 9.6 mg/l (−3.5 to 22.7, p = 0.47) and 24.8 mg/l (−17 to 67, p = 0.33), respectively. Both groups had decreased IL-6 and CRP levels at 6 weeks after surgery compared to the preoperative level. Conclusions: Elevation of IL-6 and CRP is stronger in patients over 60 years old after instrumented lumbar spinal fusion. The CRP and IL-6 are sensitive markers for acute postoperative inflammation. Even high acute CRP values do not necessarily indicate postoperative infection. peerReviewed

Objective: The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength. Methods: A total of 194 patients (mean ± standard deviation [SD] age, 61 ± 21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively. Results: The preoperative mean ± SD extension strength was 205 ± 144 N, which increased to 258 ± 142 N (p < 0. 001) at the 12-month follow-up. Flexion strength increased from 295 ± 172 N to 364 ± 164 N (p < 0. 001). The preoperative extension/flexion strength ratio was 0.75 ± 0.38 and remained similar (0.73 ± 0.26) at 12 months postoperatively (p = 0.39). Conclusion: Although trunk muscle strength increased by 26% for extension and 23% for flexion at the 12-month postoperative follow-up, both values remained objectively low. In addition, flexion strength remained higher than extension strength, which indicates an imbalance between those muscle groups. Age, severe back pain, and low trunk muscle strength before surgery predicted low trunk muscle strength at 1 year after spinal fusion.