53 research outputs found
Nissenin fundoplikaation pitkäaikaistulokset
No full textRefluksitaudista on tullut yleisin mahasuolikanavan sairaus länsimaissa. Tällä hetkellä valtamenetelmänä oleva kirurginen hoito, Nissenin fundoplikaatio, kehitettiin alun perin vuonna 1955, ja ensimmäinen tähystysavusteinen fundoplikaatio tehtiin vuonna 1991. Vaikka leikkausmenetelmä on jo 60 vuotta vanha, pitkäaikaistuloksia, jotka kuvaavat menetelmän käyttöä valikoimattomissa potilasaineistoissa, on julkaistu vähän. Pisimmät seurantatutkimukset rajoittuvat ylipäätään 20 vuoteen.
Tämä väitöskirjatyö koostuu neljästä vertaisarvioidusta alkuperäisartikkelista. Ensimmäisessä osatyössä (I) tavoitteemme oli kuvata leikkaushoidon aiheet, leikkaustekniikka sekä vuotuiset leikkausmäärät Kanta-Hämeen keskussairaalassa tähystysavusteisen leikkaustekniikan käyttöönoton jälkeen. Tuloksiemme mukaan leikkausmäärät lisääntyivät merkittävästi tähystysleikkausten myötä. Vaikka leikkausaiheena oli objektiivisilla tutkimusmenetelmillä todettu refluksitauti, leikkausmäärän kasvamisen katsottiin johtuvan leikkausaiheiden laajenemisesta koskemaan suurempaa potilasjoukkoa. Leikkaustekniikka kehittyi standardoidummaksi 90-luvun loppua kohti.
Toinen (II) ja kolmas (III) osatyömme käsittelivät Kanta-Hämeen keskussairaalassa tähystysavusteisesti fundoplikaatio-leikattujen potilaiden pitkäaikaistuloksia. Toisessa (II) osatyössä tavoitteemme oli määritellä leikkauspotilaiden elämänlaatu kymmenen vuotta leikkauksen jälkeen. Kolmannessa (III) osatyössä halusimme selvittää leikkaustuloksen kestävyyttä valikoimattomassa potilasaineistossa, fibriiniliiman vaikutusta leikkaustulokseen sekä potilaiden oireilua ja tyytyväisyyttä. Tutkimustemme mukaan leikkauspotilaiden elämänlaatu oli lähes vastaava kuin suomalaisella verrokkiväestöllä. Suurin osa potilaista oli tyytyväisiä leikkaustulokseen, mutta tyytymättömyys oli yhteydessä alentuneeseen elämänlaatuun. Ilmavaivat ja nielemisvaikeudet olivat yleisimpiä hoitoon liittyviä sivuvaikutuksia, ja nielemisvaikeudet olivat yleisin ongelma tyytymättömillä potilailla. Ehjiksi todettiin 89 % fundoplikaatio-manseteista, ja vain 6 % potilaista ilmoitti olevansa tyytymättömiä leikkaustulokseen. Subjektiivisten ja objektiivisten tulosten katsottiin olevan vastaavat kuin aiemmin raportoidut, pidemmälle erikoistuneista yksiköistä julkaistut tulokset. Ensimmäistä kertaa fibriiniliiman käytön vaikutus yhdistettiin leikkaustuloksen pettämistä vähentäväksi tekijäksi pitkäaikaisseurannassa.
Neljännessä (IV) osatyössä halusimme selvittää Tampereen yliopistollisessa sairaalassa yli kolmekymmentä vuotta aiemmin avomenetelmällä leikattujen potilaiden subjektiiviset leikkaustulokset, elämänlaadun sekä ennen tähystysaikakautta käytössä olleet leikkausaiheet. Tuloksemme antavat viitteitä siitä, että onnistuneen Nissenin fundoplikaatio leikkauksen jälkeen potilaat saattavat saada elinikäisen avun refluksioireiluun. Potilaiden elämänlaatu todettiin vastaavaksi kuin suomalaisen verrokkiväestön yli kolmekymmentä vuotta leikkauksen jälkeen. Leikkausaiheiden katsottiin heijastavan 80-luvulla vallinneita käytäntöjä. Suurimmalla osalla potilaista oli objektiivisesti varmistettu refluksitauti.
Tähystysavusteisella Nissenin fundoplikaatiolla on saavutettavissa kestävä leikkaustulos myös valikoimattomissa potilasaineistoissa. Onnistuneella leikkaustuloksella on mahdollisesti saavutettavissa elinikäinen helpotus refluksioireiluun, mutta leikkaukseen liittyvät potentiaaliset riskit ja sivuvaikutukset on otettava huomioon mietittäessä kirurgista hoitoa hoitovaihtoehtona. Sekä kirurgit että potilaat voivat hyödyntää tämän väitöskirjan tuloksia arvioidessaan hoitoon liittyviä hyötyjä ja haittoja.Gastroesophageal reflux disease has become the most common gastrointestinal disorder in the Western world. The currently prevailing surgical treatment, Nissen fundoplication, was originally developed in 1955, and the laparoscopic technique was utilized for the first time in 1991. There are few pragmatic studies presenting long-term results of laparoscopic Nissen fundoplication from routine clinical practice, and even though the treatment method is 60 years old, the longest follow-up studies are limited to 20 years.
This thesis consists of four independent articles. The aim of our first study (I) was to describe the indications, operative technique, and annual rates of antireflux surgery at Kanta-Häme Central Hospital after the dissemination of the laparoscopic technique. The results showed that, after the introduction of the laparoscopic technique, the number of antireflux operations rose markedly. Although only patients with objectively verified GERD were treated, the rise in the operation rates was considered to be a result of the broadening of the indications to include a wider range of patients. The operative technique became more standardized towards the end of the 1990s.
Our second (II) and third (III) articles concerned the long-term results of laparoscopic Nissen fundoplication at Kanta-Häme Central Hospital. In our second study (II), the aim was to define the ten-year results as regards the health-related quality of life of our patient cohort. The objective of our third study (III) was to describe the long-term durability of surgical results in routine clinical practice, the impact of fibrin glue on the incidence of surgical failure, and the subjective outcomes ten years after the operation. We found that the health-related quality of life of the patient cohort was close to that of the Finnish general population. The patient satisfaction was high, but dissatisfaction with the treatment was associated with the decreased health-related quality of life. Flatulence and dysphagia were the most common side effects of the treatment, while dysphagia was the most common problem among the dissatisfied. Eighty-nine percent of the fundoplication wraps were intact, and only 6% of the patients were unsatisfied with the results. The subjective and objective long-term results were comparable to those published from more specialized centers. For the first time, it was noted that the use of fibrin glue seemed to decrease the incidence of defective fundoplication wraps in the long term.
In our fourth (IV) article, we aimed to present almost lifelong follow-up (>30 years) after open Nissen fundoplication in terms of subjective outcomes and health-related quality of life and to describe the indications for antireflux surgery before the laparoscopic era. According to our results, a successful Nissen fundoplication may provide a lifelong control of reflux symptoms, and the health-related quality of life of the patients was comparable to that of the general population over 30 years after the operation. The indications for the procedure reflected the practices of the time, and, in most of the patients, GERD was objectively verified.
The results of this thesis suggest that laparoscopic Nissen fundoplication can provide durable surgical results in routine clinical practice as well. In the case of successful surgery, fundoplication may give the patient a lifelong relief of reflux symptoms, but the potential risks and treatment-related side effects should be weighed cautiously when considering operative treatment. These results provide information for physicians and patients when weighing the benefits and harms of the treatment
Duet: VR Pair Dancing with Partner Movement Manipulation
No full textPublisher Copyright: © 2024 Copyright held by the owner/author(s). | openaire: EC/H2020/101017779/EU//CAROUSELDancing provides a powerful way for one to feel connected with others. Virtual Reality (VR) holds the promise of enabling shared dancing experiences over a distance, but major challenges remain. First, the average VR user is limited to moving in a small real-world space; techniques that allow movement in a larger-than-real virtual space all have their limitations. Second, the lack of force feedback, combined with the latency of networking, movement tracking, graphics rendering, and human visuomotor control, makes it difficult to mimic physical interaction such as holding hands—one typically cannot react fast enough to one’s dance partner’s movements to maintain connection. Third, reliable full-body movement tracking remains beyond reach for affordable consumer VR devices such as Meta Quest. Here, we present a two-player VR contemporary dance game/experience that provides a new solution to these problems. Our solution combines 1) a novel partner movement manipulation approach where each player only needs a small physical space to move, but their perception of their partner’s movement is manipulated to allow the choreography to utilize a large virtual space, 2) a latency-tolerant visual metaphor for connection, in the form of an elastic string connecting the players, and 3) abstract avatar design that only requires tracking the movement of the hands and head and also increases the plausibility of the movement manipulation.Peer reviewe
Performance of thin Vivacit-E hip liners: no relevant wear during ex vivo testing at high acetabular inclination angle
No full textBackground and purpose: There is concern among clinicians regarding the performance of thin, highly cross-linked polyethylene acetabular liners at high inclination angles that cause edge contact and high contact stresses. We studied ex vivo wear performance of thin, vitamin-E grafted, highly cross-linked polyethylene (Vivacit-E) liners in relation to high acetabular inclination angle.
Materials and methods: Wear of Vivacit-E acetabular liners (thickness 4.0–5.7 mm) was studied with a validated hip joint simulator at 2 different acetabular inclination angles, 40° (optimal) and 65° (high). The test simulated walking. Wear was evaluated gravimetrically and dimensionally.
Results: At the optimal inclination angle, slight weight gain occurred. At the high angle, the liners lost weight slightly. Due to the minimal weight loss, gravimetric wear rates were difficult to determine. Linear wear was below the detection limit of 0.01 mm.
Conclusion: Even with the high acetabular inclination angle, the prostheses performed well in the present test conditions. The wear rates of the liners were estimated to be clearly below the osteolysis threshold of 0.05 mm/year, below which osteolysis is absent. Since the present hip joint simulator has been shown to produce clinically relevant wear, these ex vivo results are likely to reflect the in vivo behavior of the design
Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion—A multicenter cohort study
No full textBackground: Randomized controlled trials have demonstrated an improved outcome of basilar artery occlusion (BAO) with endovascular thrombectomy (EVT) compared to best medical treatment. However, a minority of the patients recruited up to 12–24 h from onset in the positive trials received intravenous thrombolysis (IVT), and a trial with a higher IVT rate did not show superiority of EVT. Thus, the efficacy and safety of EVT compared to IVT for BAO remain less clear. Aims: We aimed to compare outcomes after IVT alone to EVT with or without IVT for acute BAO. Methods: This international, observational, retrospective study included patients who received recanalization therapy for BAO at six centers between January 2010 and March 2024. The primary outcome was 3-month modified Rankin Scale (mRS) score 0–3, and secondary outcomes comprised mRS 0–2, ordinal mRS, mortality, and symptomatic intracranial hemorrhage. Outcomes after IVT versus EVT ± IVT were compared using inverse probability-weighted regression adjustment models adjusting for known predictors of outcome in BAO and baseline variables differing between the treatment groups. Interaction of the treatment group with symptom severity and onset-to-treatment time was tested. Results: Of 523 patients with BAO (median age 69, 35.2% women), 28.9% received IVT and 71.1% EVT ± IVT. The IVT-alone group had a lower baseline National Institutes of Health Stroke Scale score (median 11 vs 15) but equally extensive ischemic changes in baseline imaging. After inverse probability-weighted regression adjustment, the IVT-alone group had higher odds of mRS 0–3 (adjusted odds ratio (aOR) = 2.33 [95% confidence interval (CI) = 1.31–4.12]), mRS 0–2 (aOR = 1.93 [95% CI = 1.12–3.30]), lower median mRS (aOR = 1.81 [95% CI = 1.21–2.71]), and lower mortality (aOR = 0.53 [95% CI = 0.29–0.97]), but no difference in symptomatic intracranial hemorrhage (aOR = 0.81 [95% CI = 0.28–2.36]). No interactions for the primary outcome were found. Conclusion: In this study, patients with BAO had better outcome after IVT than EVT ± IVT independent of symptom severity and time from onset. Although the non-randomized design of the study warrants caution, the results encourage further trials comparing EVT and IVT to guide recanalization therapy in BAO patients. Data access statement: Anonymized data are available upon reasonable request to the corresponding author following the national legislation.Peer reviewe
Author Correction: Multitrophic arthropod diversity mediates tree diversity effects on primary productivity
No full textIncreased risk for dislocation after introduction of the Continuum cup system : lessons learnt from a cohort of 1,381 THRs after 1-year follow-up
No full textWear of Femoral Head Taper Connections of Contemporary Total Hip Prostheses: An Experimental Study
No full textPurpose: Progress in the design of total hip prostheses has enhanced the long-term results of total hip arthroplasty. However, recent clinical failures have raised concerns regarding the long-term performance of taper connections. Issues at the taper connection of the femoral head can lead to implant failure and revision surgery. There is scarcity of published studies on the wear performance of contemporary femoral head taper connections in carefully controlled laboratory tests. This work aims to help remedy this shortcoming. Methods: The study comprised dynamic load frame tests and multidirectional hip joint simulator tests for two contemporary prosthesis designs with titanium alloy femoral stems and CoCr and zirconia toughened alumina (ZTA) femoral heads of 36 mm diameter and medium neck length against vitamin E stabilized, highly cross-linked polyethylene liners (n = 3). Worn surfaces were analyzed by optical and scanning electron microscopy (SEM). Results: Wear was more prominent in the inferior and distal parts of the CoCr head tapers, and these regions aligned with those of the trunnions that showed most wear. Wear marks on CoCr heads were relatively mild, indicative of fretting due to micromotion. Material displacement occurred locally without dislodged debris. ZTA heads mainly showed titanium transfer by adhesive wear. ZTA femoral heads outperformed CoCr heads regarding wear resistance and surface stability. The 12/14 tapers showed more pronounced wear and surface modifications compared with Type 1 tapers. EDX analysis confirmed the absence of adhesion between CoCr and Ti alloy, and increased oxygen percentage on worn regions. Conclusion: The wear marks were mild. No serious damage was observed. The wear behavior of the taper connections appeared satisfactory, and not a cause for concern in the short term.Peer reviewe
Proseduraalinen pulmasuunnittelu peliin Tomorrow Island
No full textThis thesis explores procedural content generation as a method for generating levels for puzzle games. Even with many games incorporating random elements or procedural content generation methods in their design, most game content is still designed by human designers. Especially, in the context of puzzle games, the content generation tools have to be tailored to a specific game, which means designing solutions for new games is a challenge. This work explores procedural puzzle generation by implementing a generate-and-test algorithm that can generate levels for a turn-based puzzle game, Tomorrow Island, co-designed by the author.
The quality of generated puzzles varies, yielding both high and low ratings from the playtesters in a small-scale quantitative survey. Overall, the generated puzzles are outperformed by reference puzzles designed by the author in all four measured aspects: Challenge, Fun, Visually Pleasing, and Likelihood of being created by a human designer. Based on the results, the work offers insight into further developing procedural puzzle generation algorithms for Tomorrow Island.Tässä opinnäytetyössä tutkitaan proseduraalisen sisällöntuotannon menetelmiä työkaluna pulmapelien kenttien automaattiseksi luomiseksi. Vaikka nykypäivänä monet pelit jo hyödyntävätkin satunnaisuutta tai proseduraalisen sisällöntuotannon menetelmiä, suurin osa pelisisällöstä on yhä ihmissunnittelijoiden luomaa. Erityisesti pulmapelejä varten proseduraalisen sisällöntuotannon työkalut täytyy suunnitella joka kerta erikseen, jolloin ratkaisun suunnitteleminen uudelle pelille on aina oma ongelmansa. Tämä työ tarkastelee proseduraalisen sisällöntuotannon haastetta toteuttamalla automaattisesti kenttiä luovan ja arvioivan algoritmin vuoropohjaiseen Tomorrow Island -pulmapeliin, jota työn kirjoittaja on ollut mukana suunnittelemassa.
Peliin automaattisesti luotujen pulmien laatu vaihtelee pelitestaajien antaessa sekä korkeita että matalia arvosanoja luoduille kentille pienimuotoisessa kvantitatiivisessa kyselytutkimuksessa. Automaattisesti luotujen pulmien laatu on kuitenkin keskimäärin matalampi kuin työn kirjoittajan verrokeiksi suunnittelemat pulmat jokaisessa neljässä mitattavana olleessa piirteessä: Haastavuus, Hauskuus, Visuaalinen miellyttävyys ja Ihmisen suunnitteleman näköisyys. Tulosten perusteella työ käsittelee mahdollisuuksia Tomorrow Island -peliin luotavien pulmien laadun parantamiseksi
Implant survival of 662 dual-mobility cups and 727 constrained liners in primary THA: small femoral head size increases the cumulative incidence of revision
No full textBackground and purpose — In total hip arthroplasty (THA), the risk for dislocation can be reduced using either dual-mobility cups (DMCs) or constrained liners (CLs). There are few studies comparing these concepts in primary THA. Therefore, we compared the cumulative incidence of revision in primary THA patients treated with DMC or CL with varying head sizes with conventional THA patients as reference group. Patients and methods — We performed a cohort study based on the Finnish arthroplasty register, comparing DMCs and CLs operated over the period 2000–2017. DMCs were divided into 2 groups based on the implant design: “DMC Trident” group (n = 399) and “DMC Others” group (n = 263). CLs were divided based on the femoral head size: “CL 36 mm” group (n = 425) and “CL < 36 mm” group (n = 302). All conventional primary THAs operated on in 2000–2017 with 28–36 mm femoral head were included as control group (“Conventional THA” group, n = 102,276). Implant survival was calculated by the corresponding cumulative incidence function with revision as the endpoint and death as competing event. Also, the prevalence of different reasons for revision was compared. Results — The 6-year cumulative incidence function estimates for the first revision were 6.9% (95% CI 4.0–9.7) for DMC Trident, 5.0% (CI 1.5–8.5) for DMC Others, 13% (CI 9.3–17) for CL < 36 mm, 6.3% (3.7–8.9) for CL 36 mm, and 4.7% (CI 4.5–4.8) for control group (conventional THA). The prevalence of dislocation revision was high (5.0%, CI 2.9–8.2) in the CL < 36 mm group compared with other groups. Interpretation — The DMC and CL 36 mm groups had promising mid-term survival rates, comparable to those of primary conventional THA group. The revision rate of CLs with < 36 mm head was high, mostly due to high prevalence of dislocation revisions. Therefore, CLs with 36 mm femoral head should be preferred over smaller ones
Are some neutral liners more neutral than others? An ex vivo morphological analysis of acetabular liners classified as “neutral”
No full textBackground and purpose: In contemporary total hip replacement (THR), dislocation is one of the most common complications. At our institution, the cause of an increase in the dislocation rate was recently reported to be reduced head coverage of a newly introduced neutral liner. We therefore aimed to ascertain whether differences exist in articulating head coverage between the various neutral liners used in contemporary THR. A secondary aim was to utilize coverage measurements to develop a new liner coverage classification.
Methods: The articulating head coverage of 25 modular neutral polyethylene liners used in 6 uncemented cup designs from 4 major manufacturers was evaluated. The measurements were performed in a metrology laboratory and a mathematical model was developed to calculate coverage of the articulating surfaces. Further, 1 “elevated rim” liner and 1 “face changing liner” were included to develop a new liner coverage classification.
Results: The articulating head coverage among the studied liners ranged from 167.7° to 194.8°, corresponding to a variation of 27.1°. The variations with different cup and head sizes within each design were smaller (from 1.0° to 5.6°) than those between different designs. Each of the liner designs offered distinct coverage, even though they were all classified as neutral. Based on measurements, a set of descriptive parameters to discriminate different liners in terms of coverage was created.
Conclusion: We showed that all neutral liners are not equal – instead, they clearly varied in terms of their actual coverage design. We suggest our set of descriptive parameters called “hemispheric coverage index values” be used in discriminating the differences in liner coverage
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