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Autio AH, Paavola J, Tervonen J, Lång M, Elomaa AP, Huuskonen TJ, Huttunen J, Kärkkäinen V, von Und Zu Fraunberg M, Lindgren AE, Koivisto T, Kurola J, Jääskeläinen JE, Kämäräinen OP. Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm-illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months. Acta Neurochir (Wien) 2024; 166:17. [PMID: 38231317 PMCID: PMC10794262 DOI: 10.1007/s00701-024-05902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient's individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. METHODS Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient's individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.-54.) in the pseudonymized panels, tables, results, and discussion. RESULTS The aICH volumes on KUH admission (median 46 cm3) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. CONCLUSIONS Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.
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Affiliation(s)
- Anniina H Autio
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Juho Paavola
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Maarit Lång
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Neurointensive Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Antti E Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jouni Kurola
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Center for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Puustinen S, Hyttinen J, Elomaa AP, Vrzáková H. Hyperspectral placenta dataset: Hyperspectral image acquisition, annotations, and processing of biological tissues in microsurgical training. Data Brief 2023; 50:109526. [PMID: 37691737 PMCID: PMC10482730 DOI: 10.1016/j.dib.2023.109526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
The dataset consists of 101 hyperspectral images of four human placentas and six hyperspectral images of contrast dyes (i.e., indocyanine green and red and blue food colorant) that were captured in the range 515-900 nm, step = 5 nm. The hyperspectral images were manually annotated, delineating the key anatomical structures: arteries, veins, stroma, and the umbilical cord. Standard reference materials were used for flat-field correction. The dataset is instrumental for advancing machine-learning algorithms and automated classification of anatomical structures, particularly the classification of superficial and deep vessels and transparent tissue layers.
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Affiliation(s)
- Sami Puustinen
- Microsurgery Center of Eastern Finland, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio 70210, Finland
| | - Joni Hyttinen
- Faculty of Science, Forestry and Technology, University of Eastern Finland, Yliopistokatu 2, Joensuu 80100, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio 70210, Finland
| | - Hana Vrzáková
- Faculty of Science, Forestry and Technology, University of Eastern Finland, Yliopistokatu 2, Joensuu 80100, Finland
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Puustinen S, Vrzáková H, Hyttinen J, Rauramaa T, Fält P, Hauta-Kasari M, Bednarik R, Koivisto T, Rantala S, von Und Zu Fraunberg M, Jääskeläinen JE, Elomaa AP. Hyperspectral Imaging (HSI) in Brain Tumor Surgery - Evidence of Machine Learning-Based Performance. World Neurosurg 2023:S1878-8750(23)00473-4. [PMID: 37030483 DOI: 10.1016/j.wneu.2023.03.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Hyperspectral imaging (HSI) has the potential to enhance surgical tissue detection and diagnostics. Definite utilization of intraoperative HSI guidance demands validated machine learning and public datasets that currently do not exist. Moreover, current imaging conventions are dispersed, and evidence-based paradigms for neurosurgical HSI have not been declared. METHODS We presented the rationale and a detailed clinical paradigm for establishing microneurosurgical HSI guidance. In addition, a systematic literature review was conducted to summarize the current indications and performance of neurosurgical HSI systems, with an emphasis on machine learning-based methods. RESULTS The published data comprised a few case series or case reports aiming to classify tissues during glioma operations. For a multi-tissue classification problem, the highest overall accuracy of 80% was obtained using deep learning. Our HSI system was capable of intraoperative data acquisition and visualization with minimal disturbance to glioma surgery. CONCLUSIONS In a limited number of publications, neurosurgical HSI has demonstrated unique capabilities in contrast to the established imaging techniques. Multidisciplinary work is required to establish communicable HSI standards and clinical impact. Our HSI paradigm endorses systematic intraoperative HSI data collection, which aims to facilitate the related standards, medical device regulations, and value-based medical imaging systems.
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Affiliation(s)
- Sami Puustinen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Yliopistonranta 1C, 70211 Kuopio, Finland; Kuopio University Hospital, Eastern Finland Microsurgery Center, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Hana Vrzáková
- Kuopio University Hospital, Eastern Finland Microsurgery Center, Puijonlaaksontie 2, 70210 Kuopio, Finland; University of Eastern Finland, Faculty of Science and Forestry, School of Computing, Länsikatu 15, 80110 Joensuu, Finland
| | - Joni Hyttinen
- University of Eastern Finland, Faculty of Science and Forestry, School of Computing, Länsikatu 15, 80110 Joensuu, Finland
| | - Tuomas Rauramaa
- Kuopio University Hospital, Department of Clinical Pathology, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Pauli Fält
- University of Eastern Finland, Faculty of Science and Forestry, School of Computing, Länsikatu 15, 80110 Joensuu, Finland
| | - Markku Hauta-Kasari
- University of Eastern Finland, Faculty of Science and Forestry, School of Computing, Länsikatu 15, 80110 Joensuu, Finland
| | - Roman Bednarik
- University of Eastern Finland, Faculty of Science and Forestry, School of Computing, Länsikatu 15, 80110 Joensuu, Finland
| | - Timo Koivisto
- Kuopio University Hospital, Department of Neurosurgery, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Susanna Rantala
- Kuopio University Hospital, Department of Neurosurgery, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Oulu University Hospital, Department of Neurosurgery, Kajaanintie 50, 90220 Oulu, Finland; University of Oulu, Faculty of Medicine, Research Unit of Clinical Medicine, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Juha E Jääskeläinen
- Kuopio University Hospital, Department of Neurosurgery, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Antti-Pekka Elomaa
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Yliopistonranta 1C, 70211 Kuopio, Finland; Kuopio University Hospital, Eastern Finland Microsurgery Center, Puijonlaaksontie 2, 70210 Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Koskinen J, He W, Elomaa AP, Kaipainen A, Hussein A, Zheng B, Huotarinen A, Bednarik R. Utilizing Grasp Monitoring to Predict Microsurgical Expertise. J Surg Res 2023; 282:101-108. [PMID: 36265429 DOI: 10.1016/j.jss.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/22/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Most microsurgical procedures require the surgeon to use tools to grasp and hold fragile objects in the surgical site. Prior research on grasping in surgery has mostly either been in other surgical techniques or used grasping as an auxiliary metric. We focus on microsurgery and investigate what grasping can tell about microsurgical skill and suturing performance. This study lays groundwork for using automatic detection of grasps to evaluate surgical skill. METHODS Five expert surgeons and six novices completed sutures on a microsurgical training board. Video recordings of the performance were annotated for the number of grasps, while an eye tracker recorded the participants' pupil dilations for cognitive workload assessment. Performance was measured with suturing duration and the University of Western Ontario Microsurgical Skills Assessment instrument (UWOMSA). Differences in skill, suturing performance and cognitive workload were compared with grasping behavior. RESULTS Novices needed significantly more grasps to complete sutures and failed to grasp more often than the experts. The number of grasps affected the suturing duration more in novices. Decreasing suturing efficiency as measured by UWOMSA instrument was associated with increase in grasps, even when we controlled for overall skill differences. Novices displayed larger pupil dilations when averaged over a sufficiently large sample, and the difference increased after the grasp. CONCLUSIONS Grasping action during microsurgical procedures can be used as a conceptually simple yet objective proxy in microsurgical performance assessment. If the grasps could be detected automatically, they could be used to aid in computational evaluation of surgical trainees' performance.
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Affiliation(s)
- Jani Koskinen
- School of Computing, University of Eastern Finland, Joensuu, Finland.
| | - Wenjing He
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Aku Kaipainen
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Ahmed Hussein
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Antti Huotarinen
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
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Timonen T, Dietz A, Linder P, Lehtimäki A, Löppönen H, Elomaa AP, Iso-Mustajärvi M. The effect of virtual reality on temporal bone anatomy evaluation and performance. Eur Arch Otorhinolaryngol 2022; 279:4303-4312. [PMID: 34837519 PMCID: PMC9363303 DOI: 10.1007/s00405-021-07183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. METHODS A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. RESULTS The novice group made significantly more errors (p < 0.001) and with significantly longer performance time (p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p < 0.001). CONCLUSION In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.
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Affiliation(s)
- Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
| | - Antti Lehtimäki
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
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Lehtonen SJR, Vrzakova H, Paterno JJ, Puustinen S, Bednarik R, Hauta-Kasari M, Haneishi H, Immonen A, Jääskeläinen JE, Kämäräinen OP, Elomaa AP. Detection improvement of gliomas in hyperspectral imaging of protoporphyrin IX fluorescence - in vitro comparison of visual identification and machine thresholds. Cancer Treat Res Commun 2022; 32:100615. [PMID: 35905671 DOI: 10.1016/j.ctarc.2022.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND 5-aminolevulinic acid (5-ALA) - precursor of protoporphyrin IX (PpIX) - is utilized in fluorescence guided surgery (FGS) of high-grade gliomas. PpIX is used to identify traces of glioma during resection. Visual inspection of the fluorescence seems inaccurate in comparison to optic techniques such as hyperspectral imaging (HSI). AIM To characterize the limits of PpIX fluorescence detection of (i) visual evaluation and (ii) HSI analysis and to (iii) develop a classification system for visible and non-visible PpIX fluorescence. METHODS Samples with increasing concentrations (C) of PpIX and non-fluorescent controls were evaluated using a surgical microscope under blue light illumination. Similar samples were imaged with a HSI system tuned to PpIX fluorescence peak wavelength (635 nm) and control (RGB) channels. Samples' intensities were defined, leading to 96 analysed pixels after batching. RESULTS Three expert neurosurgeons assessed the PpIX samples (n = 16) and controls (n = 8) with unanimous decisions (ICC = 0.704), resulting in 63% recognition rate, 48% sensitivity, 92% specificity, 92% positive predictive value (PPV) and 47% negative predictive value (NPV). HSI image analysis, comparing mean relative values, resulted in 96%, 100%, 86%, 94%, 100%, respectively. Minimum PpIX concentration detection for experts was 0.6-1.8 μmol/l and HSI's 0.03-0.15 μmol/l. CONCLUSIONS PpIX concentrations of low-grade gliomas, and those reported on glioblastoma infiltration zones, are below experts' detection threshold. HSI analysis exceeds the performance of expert's visual inspection nearly by 20-fold. Hybrid FGS-HSI systems should be investigated in parallel to long-term outcomes. Described methods are applicable as a standard for calibration, testing and development of subvisual FGS techniques.
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Affiliation(s)
- Samu J R Lehtonen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Hana Vrzakova
- Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Jussi J Paterno
- Ophthalmology Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211 Kuopio, Finland
| | - Sami Puustinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Roman Bednarik
- School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Markku Hauta-Kasari
- School of Computing, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland; Institute of Photonics, UEF University of Eastern Finland, Länsikatu 15, 80110 Joensuu, Finland
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering (CFME), Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Arto Immonen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Antti-Pekka Elomaa
- Neurosurgery Clinical Research Unit, Institute of Clinical Sciences, School of Medicine, Faculty of Health Sciences, UEF University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland; Microneurosurgery Photonics Research Group of The Microsurgery Center of Eastern Finland, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Eastern Finland Neuro-Oncology Group, Neurosurgery of Neurocenter, KUH Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Tolvanen O, Elomaa AP, Itkonen M, Vrzakova H, Bednarik R, Huotarinen A. Eye-Tracking Indicators of Workload in Surgery: A Systematic Review. J INVEST SURG 2022; 35:1340-1349. [PMID: 35038963 DOI: 10.1080/08941939.2021.2025282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BackgroundEye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation.MethodsWe conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used" ("eye tracking" OR "gaze tracking") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)". Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted.ResultsA total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (n = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon's eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found.ConclusionPupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.
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Affiliation(s)
- Otto Tolvanen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland.,Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Matti Itkonen
- Center of Brain Science (CBS), CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Hana Vrzakova
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Kuopio, Finland
| | - Antti Huotarinen
- School of Computing, University of Eastern Finland, Kuopio, Finland
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Koskinen J, Huotarinen A, Elomaa AP, Zheng B, Bednarik R. Movement-level process modeling of microsurgical bimanual and unimanual tasks. Int J Comput Assist Radiol Surg 2021; 17:305-314. [PMID: 34913139 PMCID: PMC8784365 DOI: 10.1007/s11548-021-02537-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Purpose Microsurgical techniques require highly skilled manual handling of specialized surgical instruments. Surgical process models are central for objective evaluation of these skills, enabling data-driven solutions that can improve intraoperative efficiency. Method We built a surgical process model, defined at movement level in terms of elementary surgical actions (\documentclass[12pt]{minimal}
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\begin{document}$$n=5$$\end{document}n=5) by comparing the cosine similarity of vector representations of a microsurgical suturing training task and its different segments. Results Based on our model, the experts were significantly more efficient than the novices at using their tools individually and simultaneously. At suture level, the experts were significantly more efficient at using their left hand tool, but the differences were not significant for the right hand tool. At the level of individual suture segments, the experts had on average 21.0 % higher suturing efficiency and 48.2 % higher bi-manual efficiency, and the results varied between segments. Similarity of the manual actions showed that expert and novice surgeons could be distinguished by their movement patterns. Conclusions The surgical process model allowed us to identify differences between novices’ and experts’ movements and to evaluate their uni- and bi-manual tool use efficiency. Analyzing surgical tasks in this manner could be used to evaluate surgical skill and help surgical trainees detect problems in their performance computationally.
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Affiliation(s)
- Jani Koskinen
- School of Computing, University of Eastern Finland, 80110, Joensuu, Finland.
| | - Antti Huotarinen
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, 70211, Kuopio, Finland
- Microsurgery Center, Kuopio University Hospital, 70211, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, 70211, Kuopio, Finland
- Microsurgery Center, Kuopio University Hospital, 70211, Kuopio, Finland
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, 80110, Joensuu, Finland
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9
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Kaipainen AL, Martoma E, Puustinen T, Tervonen J, Jyrkkänen HK, Paterno JJ, Kotkansalo A, Rantala S, Vanhanen U, Leinonen V, Lehto SM, Iso-Mustajärvi M, Elomaa AP, Qvarlander S, Huuskonen TJ. Cerebrospinal fluid dynamics in idiopathic intracranial hypertension: a literature review and validation of contemporary findings. Acta Neurochir (Wien) 2021; 163:3353-3368. [PMID: 34453214 PMCID: PMC8599224 DOI: 10.1007/s00701-021-04940-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a rare disease of unknown aetiology related possibly to disturbed cerebrospinal fluid (CSF) dynamics and characterised by elevated intracranial pressure (ICP) causing optic nerve atrophy if not timely treated. We studied CSF dynamics of the IIH patients based on the available literature and our well-defined cohort. METHOD A literature review was performed from PubMed between 1980 and 2020 in compliance with the PRISMA guideline. Our study includes 59 patients with clinical, demographical, neuro-ophthalmological, radiological, outcome data, and lumbar CSF pressure measurements for suspicion of IIH; 39 patients had verified IIH while 20 patients did not according to Friedman's criteria, hence referred to as symptomatic controls. RESULTS The literature review yielded 19 suitable studies; 452 IIH patients and 264 controls had undergone intraventricular or lumbar CSF pressure measurements. In our study, the mean CSF pressure, pulse amplitudes, power of respiratory waves (RESP), and the pressure constant (P0) were higher in IIH than symptomatic controls (p < 0.01). The mean CSF pressure was higher in IIH patients with psychiatric comorbidity than without (p < 0.05). In IIH patients without acetazolamide treatment, the RAP index and power of slow waves were also higher (p < 0.05). IIH patients with excess CSF around the optic nerves had lower relative pulse pressure coefficient (RPPC) and RESP than those without (p < 0.05). CONCLUSIONS Our literature review revealed increased CSF pressure, resistance to CSF outflow and sagittal sinus pressure (SSP) as key findings in IIH. Our study confirmed significantly higher lumbar CSF pressure and increased CSF pressure waves and RAP index in IIH when excluding patients with acetazolamide treatment. In overall, the findings reflect decreased craniospinal compliance and potentially depleted cerebral autoregulation resulting from the increased CSF pressure in IIH. The increased slow waves in patients without acetazolamide may indicate issues in autoregulation, while increased P0 could reflect the increased SSP.
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Affiliation(s)
- Aku L Kaipainen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Institute of Clinical Medicine / Neurology, University of Eastern Finland, Kuopio, Finland.
| | - Erik Martoma
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tero Puustinen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Henna-Kaisa Jyrkkänen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi J Paterno
- Opthalmology KUH, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna Kotkansalo
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Susanna Rantala
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulla Vanhanen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | | | - Antti-Pekka Elomaa
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Eastern Finland Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Sara Qvarlander
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Terhi J Huuskonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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10
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Tervonen J, Adams H, Lindgren A, Elomaa AP, Kämäräinen OP, Kärkkäinen V, von Und Zu Fraunberg M, Huttunen J, Koivisto T, Jääskeläinen JE, Leinonen V, Huuskonen TJ. Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2021; 163:2703-2714. [PMID: 34169389 PMCID: PMC8437876 DOI: 10.1007/s00701-021-04877-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022]
Abstract
Background Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequelae leading to poorer neurological outcomes and predisposing to various complications. Methods A total of 2191 consecutive patients with aSAH were acutely admitted to the Neurointensive Care at the Kuopio University Hospital between 1990 and 2018 from a defined population. A total of 349 (16%) aSAH patients received a ventriculoperitoneal shunt, 101 with an adjustable valve (2012–2018), 232 with a fixed pressure valve (1990–2011), and 16 a valveless shunt (2010–2013). Clinical timelines were reconstructed from the hospital records and nationwide registries until death (n = 120) or June 2019. Results Comparing the adjustable valves vs. the fixed pressure valves vs. the valveless shunts, intraventricular hemorrhage was present in 61%, 44% and 100%, respectively. The median times to the shunt were 7 days vs. 38 days vs. 10 days. The rates of the first revision were 25% vs. 32% vs. 69%. The causes included infection in 11% vs. 7% vs. 25% and overdrainage in 1% vs. 4% vs. 31%. The valveless shunt was the only independent risk factor (HR 2.9) for revision. After the first revision, more revisions were required in 48% vs. 52% vs. 45%. Conclusions The protocol to shunt evolved over time to favor earlier shunt. In post-aSAH hydrocephalus, adjustable valve shunts, without anti-siphon device, can be installed at an early phase after aSAH, in spite of intraventricular blood, with a modest risk (25%) of revision. Valveless shunts are not recommendable due to high risk of revisions.
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Affiliation(s)
- Joona Tervonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Hadie Adams
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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11
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Chainey J, Elomaa AP, O'Kelly CJ, Kim MJ, Bednarik R, Zheng B. Eye-Hand Coordination of Neurosurgeons: Evidence of Action-Related Fixation in Microsuturing. World Neurosurg 2021; 155:e196-e202. [PMID: 34400325 DOI: 10.1016/j.wneu.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined performance differences between expert and novice neurosurgeons under a surgical microscope with the goal to evaluate surgical expertise. METHODS The Tobii eye-tracker was used to record surgeons' eye movements while they performed a microsuturing task. A total of 19 expert and 18 novice trials were recorded under the microscope. Surgical videos were annotated to label subtasks and critical actions. Total suturing time and subtask times were also compared between novice and expert surgeons. At 3 critical and discrete surgical actions (needle piercing into tissue, exiting, and thread cutting) we examined eye fixation that was directly coupled to each of these actions. RESULTS Compared with novices, expert surgeons completed the suture with shorter total time (258.52 ± 102.14 seconds vs. 330.02 ± 96.52 seconds, P = 0.038), penetration time (17.15 ± 3.50 seconds vs. 26.26 ± 18.58 seconds, P = 0.043), and knot-tying time (194.63 ± 94.55 seconds vs. 262.52 ± 79.05 seconds, P = 0.025). On average, experts displayed longer fixation (1.62 seconds) and preaction fixation time (1.3 seconds) than novices (fixation time = 1.24 seconds, P = 0.048; preaction fixation = 0.82 seconds, P = 0.005)). Experts maintained their visual engagement constantly over the 3 levels of subtasks while novices required a longer fixation time for the challenging piercing action than for the exiting and cutting action. CONCLUSIONS The action-related fixation can be used to evaluate microsurgeons' level of expertise and in surgical education for gaze training.
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Affiliation(s)
- Jonathan Chainey
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Cian J O'Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Michael J Kim
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada.
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12
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Säteri T, Nurro J, Hätinen OP, Hakulinen M, Leinonen V, Elomaa AP. 'Ex Vivo Porcine Models Are Valid for Testing and Training Microsurgical Lumbar Decompression Techniques'. World Neurosurg 2021; 155:e64-e74. [PMID: 34380085 DOI: 10.1016/j.wneu.2021.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal surgeries are the leading causes for patient settlement issues. Recent European Medical Device Regulations aims to reduce complications by enforcing that surgical tools are validated before clinical use. Human cadavers are favored in preclinical use, but due to anatomical variance, decay and scarce supply, alternative synthetic and animal models are used. This study evaluates the fidelity and validity of porcine models in training and assessment of microsurgical decompressive techniques in lumbar spine. METHODS Anatomical dimensions of ten human and five young pig spines were assessed from CT images. Novel 'en bloc' fresh-frozen ex vivo porcine model tissues' fidelity and validity for decompressive surgery was evaluated by three expert neurosurgeons, in comparison to other models. RESULTS The pig's anatomical dimensions were on average 11% smaller than in humans. The pig's L4-L5 was most alike humans and highest similarity was in lamina and spinous process widths, and skin to posterior longitudinal ligament distance. Dimensional variability was higher in humans (F = 19.06-0.56, p<0.05). The pig's tissues were felt as good as living patients and better than cadavers for skin, fascia, bone, facets, ligamentum flavum and dura, but poor for vessels (experts ICC=0.696-0.903). The pig models validity for assessing drills adverse features (friction, jitter, heating, and soft tissue trauma) were reported unanimously excellent. CONCLUSION Pigs are representative for assessing microsurgical decompression techniques in the lower lumbar spine. The novel 'en bloc' pig model can be an asset for industries and clinicians during assessment and training of new spinal techniques.
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Affiliation(s)
- Tuomas Säteri
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland.
| | - Jussi Nurro
- University of Eastern Finland, AIV Institute, Kuopio, Finland; Saparo Translational Research Oy, Kuopio, Finland
| | | | | | - Ville Leinonen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland
| | - Antti-Pekka Elomaa
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland; Kuopio University Hospital, Microsurgery Center www.microsurgerycenter.com, Kuopio, Finland
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13
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Timonen T, Iso-Mustajärvi M, Linder P, Lehtimäki A, Löppönen H, Elomaa AP, Dietz A. Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study. Eur Arch Otorhinolaryngol 2020; 278:2795-2806. [PMID: 32964264 PMCID: PMC8266780 DOI: 10.1007/s00405-020-06360-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Consumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface. METHODS Five experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey. RESULTS A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland-Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001). CONCLUSION Our study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.
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Affiliation(s)
- Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
| | - Antti Lehtimäki
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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14
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Puustinen S, Alaoui S, Bartczak P, Bednarik R, Koivisto T, Dietz A, von Und Zu Fraunberg M, Iso-Mustajärvi M, Elomaa AP. Spectrally Tunable Neural Network-Assisted Segmentation of Microneurosurgical Anatomy. Front Neurosci 2020; 14:640. [PMID: 32694976 PMCID: PMC7339939 DOI: 10.3389/fnins.2020.00640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Distinct tissue types are differentiated based on the surgeon’s knowledge and subjective visible information, typically assisted with white-light intraoperative imaging systems. Narrow-band imaging (NBI) assists in tissue identification and enables automated classifiers, but many anatomical details moderate computational predictions and cause bias. In particular, tissues’ light-source-dependent optical characteristics, anatomical location, and potentially hazardous microstructural changes such as peeling have been overlooked in previous literature. Methods Narrow-band images of five (n = 5) facial nerves (FNs) and internal carotid arteries (ICAs) were captured from freshly frozen temporal bones. The FNs were split into intracranial and intratemporal samples, and ICAs’ adventitia was peeled from the distal end. Three-dimensional (3D) spectral data were captured by a custom-built liquid crystal tunable filter (LCTF) spectral imaging (SI) system. We investigated the normal variance between the samples and utilized descriptive and machine learning analysis on the image stack hypercubes. Results Reflectance between intact and peeled arteries in lower-wavelength domains between 400 and 576 nm was significantly different (p < 0.05). Proximal FN could be differentiated from distal FN in a higher range, 490–720 nm (p < 0.001). ICA with intact tunica differed from proximal FN nearly thorough the VIS range, 412–592 nm (p < 0.001) and 664–720 nm (p < 0.05) as did its distal counterpart, 422–720 nm (p < 0.001). The availed U-Net algorithm classified 90.93% of the pixels correctly in comparison to tissue margins delineated by a specialist. Conclusion Selective NBI represents a promising method for assisting tissue identification and computational segmentation of surgical microanatomy. Further multidisciplinary research is required for its clinical applications and intraoperative integration.
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Affiliation(s)
- Sami Puustinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Soukaina Alaoui
- School of Computing, Faculty of Science and Forestry, University of Eastern Finland, Joensuu, Finland
| | - Piotr Bartczak
- School of Computing, Faculty of Science and Forestry, University of Eastern Finland, Joensuu, Finland
| | - Roman Bednarik
- School of Computing, Faculty of Science and Forestry, University of Eastern Finland, Joensuu, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Aarno Dietz
- Department of Otolaryngology, Kuopio University Hospital, Kuopio, Finland
| | | | - Matti Iso-Mustajärvi
- Department of Otolaryngology, Kuopio University Hospital, Kuopio, Finland.,Eastern Finland Center of Microsurgery, Kuopio University Hospital, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Eastern Finland Center of Microsurgery, Kuopio University Hospital, Kuopio, Finland
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15
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Abstract
Background. Evaluation of microsurgical proficiency is conventionally subjective, time consuming, and unreliable. Eye movement–based metrics have been promising not only in detection of surgical expertise but also in identifying actual cognitive stress and workload. We investigated if pupil dilations and blinks could be utilized in parallel to accurately classify microsurgical proficiency and its moderating features, especially task-related stress. Methods. Participants (n = 11) were divided into groups based on prior experience in microsurgery: novices (n = 6) with no experience and trained microsurgeons (n = 5). All participants conducted standardized suturing tasks with authentic instruments and a surgical microscope. A support vector machine classifier was used to classify features of microsurgical expertise based on percentage changes in pupil size. Results. A total of 109 successful sutures with 1090 segments were recorded. Classification of expertise from sutures achieved accuracies between 74.3% and 76.0%. Classification from individual segments based on these same features was not feasible. Conclusions. Combined gaze metrics are applicable for classifying surgical proficiency during a defined task. Pupil dilation is also sensitive to external stress factors; however, the usefulness of blinks is impaired by low blink rates. The results can be translated to surgical education to improve feedback and should be investigated individually in the context of actual performance and in real patient operations. Combined gaze metrics may be ultimately utilized to help microsurgeons monitor their performance and workload in real time—which may lead to prevention of errors.
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Affiliation(s)
- Jani Koskinen
- School of Computing, 163043University of Eastern Finland, Finland
| | - Roman Bednarik
- School of Computing, 163043University of Eastern Finland, Finland
| | - Hana Vrzakova
- Microsurgery Center, 60650Kuopio University Hospital, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Center, 60650Kuopio University Hospital, Finland.,Department of Neurosurgery, Institute of Clinical Medicine, 60650Kuopio University Hospital, Finland
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16
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Puustinen T, Tervonen J, Avellan C, Jyrkkänen HK, Paterno JJ, Hartikainen P, Vanhanen U, Leinonen V, Lehto SM, Elomaa AP, Huttunen TJ. Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension. Clin Neurol Neurosurg 2019; 186:105527. [PMID: 31586855 DOI: 10.1016/j.clineuro.2019.105527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Idiopathic intracranial hypertension (IIH) is aetiologically unknown disorder that associates with endocrinological disturbances, including dysfunction of hypothalamic-pituitary-adrenal-axis. Neuroendocrinological dysfunctions have also been characterized in psychiatric disorders, and therefore we investigated the presence of psychiatric disorders of patients with IIH in a well-defined cohort. PATIENTS AND METHODS A total of 51 patients with IIH were included. Patient demographics, symptoms, imaging data, ophthalmological and clinical findings were collected. RESULTS At the time of diagnosis the mean age was 32.5years (SD 10.7), the body mass index was 37.1 kg/m2 (SD 7.4), and the opening pressure 29.1 mmHg (SD 6.2). A total of 88.2% of patients were female and 45.1% were diagnosed with a psychiatric co-morbidity prior to IIH diagnosis. The mean follow-up time was 4.4 years (SD 5.4). The overall treatment outcome was significantly poorer on a group of patients with psychiatric diagnosis when compared to individuals without such history (p = 0.001), but there were no differences in the resolution of papilledema (p = 0.405). Patients with IIH and psychiatric disorders had more often empty sella on their imaging at diagnosis when compared to patients without psychiatric co-morbidity (p = 0.044). CONCLUSION Psychiatric disorders are highly prevalent in patients with IIH and associate with worse subjective outcomes. These findings advocate for monitoring the mental health of patients with IIH and warrant further multidisciplinary research to understand the potentially underlying psychosocial and neuroendocrinological mechanisms.
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Affiliation(s)
- Tero Puustinen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joona Tervonen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Cecilia Avellan
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Henna-Kaisa Jyrkkänen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi J Paterno
- Opthalmology KUH, Kuopio University Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neurology KUH NeuroCenter, Kuopio University Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulla Vanhanen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Soili M Lehto
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huttunen
- Neurosurgery KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
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Huuskonen P, Keski-Nisula L, Heinonen S, Voutilainen S, Tuomainen TP, Pekkanen J, Lampi J, Lehto SM, Haaparanta H, Elomaa AP, Voutilainen R, Backman K, Kokki H, Kumpulainen K, Paananen J, Vähäkangas K, Pasanen M. Kuopio birth cohort - design of a Finnish joint research effort for identification of environmental and lifestyle risk factors for the wellbeing of the mother and the newborn child. BMC Pregnancy Childbirth 2018; 18:381. [PMID: 30241516 PMCID: PMC6150990 DOI: 10.1186/s12884-018-2013-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A Finnish joint research effort Kuopio Birth Cohort (KuBiCo) seeks to evaluate the effects of genetics, epigenetics and different risk factors (medication, nutrition, lifestyle factors and environmental aspects) during pregnancy on the somatic and psychological health status of the mother and the child. METHODS KuBiCo will ultimately include information on 10,000 mother-child pairs who have given their informed consent to participate in this cohort. Identification of foetal health risk factors that can potentially later manifest as disease requires a repository of relevant biological samples and a flexible open up-to-date data handling system to register, store and analyse biological, clinical and questionnaire-based data. KuBiCo includes coded questionnaire-based maternal background data gathered before, during and after the pregnancy and bio-banking of maternal and foetal samples that will be stored in deep freezers. Data from the questionnaires and biological samples will be collected into one electronic database. KuBiCo consists of several work packages which are complementary to each other: Maternal, foetal and placental metabolism and omics; Paediatrics; Mental wellbeing; Prenatal period and delivery; Analgesics and anaesthetics during peripartum period; Environmental effects; Nutrition; and Research ethics. DISCUSSION This report describes the set-up of the KuBiCo and descriptive analysis from 3532 parturients on response frequencies and feedback to KuBiCo questionnaires gathered from June 2012 to April 2016. Additionally, we describe basic demographic data of the participants (n = 1172). Based on the comparison of demographic data between official national statistics and our descriptive analysis, KuBiCo represents a cross-section of Finnish pregnant women.
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Affiliation(s)
- Pasi Huuskonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, FI-70211, Kuopio, Finland.,Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI-00029, Helsinki, Finland
| | - Sari Voutilainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Juha Pekkanen
- Department of Public Health, University of Helsinki, FI-00014, Helsinki, Finland.,Department of Health Protection, National Institute for Health and Welfare, FI-70210, Kuopio, Finland
| | - Jussi Lampi
- Department of Health Protection, National Institute for Health and Welfare, FI-70210, Kuopio, Finland
| | - Soili M Lehto
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland and Kuopio University Hospital, FI-70211, Kuopio, Finland.,Institute of Behavioural Sciences, University of Helsinki, FI-00014, Helsinki, Finland
| | - Hannariikka Haaparanta
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland and Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Paediatrics, Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Katri Backman
- Department of Paediatrics, Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Hannu Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, FI-70211, Kuopio, Finland
| | - Kirsti Kumpulainen
- Department of Child Psychiatry, Institute of Clinical Medicine, University of Eastern Finland and Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Jussi Paananen
- Department of Biomedicine, University of Eastern Finland and Kuopio University Hospital, FI-70211, Kuopio, Finland
| | - Kirsi Vähäkangas
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Markku Pasanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
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18
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Elomaa AP, Viinamäki H, Harvima IT, Koivumaa-Honkanen H, Honkalampi K, Valkonen-Korhonen M, Lehto SM. Increased mitogen-stimulated lymphocyte proliferation is associated with the clinical response in major depressive disorder in women: A follow-up study. Psychiatry Res 2016; 239:220-1. [PMID: 27019038 DOI: 10.1016/j.psychres.2016.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/14/2016] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Antti-Pekka Elomaa
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland.
| | - Heimo Viinamäki
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, FI-70211 Kuopio, Finland
| | - Ilkka T Harvima
- Department of Dermatology, University of Eastern Finland, FI-70211 Kuopio, Finland; Department of Dermatology, Kuopio University Hospital, FI-70211 Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, FI-70211 Kuopio, Finland; SOTE, Iisalmi, FI-70211 Kuopio, Finland; SOSTERI, Savonlinna, Finland; North Karelia Central Hospital, FI-80210 Joensuu, Finland; South-Savonia Hospital District, Mikkeli, Finland; Departments of Psychiatry, Lapland Hospital District, FI-96101 Rovaniemi, Finland; Clinic of Child Psychiatry, Oulu University Hospital, FI-90029 Oulu, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, FI-80101 Joensuu, Finland
| | - Minna Valkonen-Korhonen
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, FI-70211 Kuopio, Finland
| | - Soili M Lehto
- Department of Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, FI-70211 Kuopio, Finland
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Luojus MK, Lehto SM, Tolmunen T, Elomaa AP, Kauhanen J. Reply to Dr. Kawada "Short sleep duration and serum copper". J Trace Elem Med Biol 2016; 35:123. [PMID: 26854111 DOI: 10.1016/j.jtemb.2016.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Maria K Luojus
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Soili M Lehto
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland.
| | - Tommi Tolmunen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland.
| | - Antti-Pekka Elomaa
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
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20
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Luojus MK, Lehto SM, Tolmunen T, Elomaa AP, Kauhanen J. Serum copper, zinc and high-sensitivity C-reactive protein in short and long sleep duration in ageing men. J Trace Elem Med Biol 2015; 32:177-82. [PMID: 26302926 DOI: 10.1016/j.jtemb.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Serum levels of zinc and copper have been proposed to associate with sleep duration. Mechanisms, such as inflammatory processes, have been suggested to relate this association. However, earlier studies have been conducted in small sample sizes. Human studies investigating the suggested associations while controlling for potential confounding factors are lacking. METHODS Population-based data consisted of 2570 men (aged 42-60 years) from Eastern Finland. The participants reported an estimate of their sleep duration. The serum levels of zinc (S-Zn), copper (S-Cu) and high-sensitivity C-reactive protein (hs-CRP) were measured. Analysis of covariance was used for multivariate analyses. RESULTS S-Zn levels and Zn/Cu ratio were lowest in ≤6h sleep. S-Cu levels were highest in ≥10h sleep. Elevated levels (>3.0mmol/l) of hs-CRP were observed in ≤6h and ≥10h sleep. After adjustments for age, cumulative smoking history (pack-years), alcohol consumption (g/week), Human Population Laboratory depression scale scores, physical activity (kcal/day), cardiometabolic syndrome, and cardiovascular disease history, sleep duration was significantly associated with levels of both S-Cu and hs-CRP. The association with S-Cu remained statistically significant following further adjustment for hs-CRP in the same model. CONCLUSIONS Our data suggests an association between S-Cu and sleep duration in ageing men. Elevated inflammation (measured as serum hs-CRP) does not explain this relationship. Mechanisms underlying the relationship require further investigation, as S-Cu may contribute to sleep regulation through pro-oxidative processes and copper-dependent N-methyl-d-aspartate receptor activity.
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Affiliation(s)
- Maria K Luojus
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Soili M Lehto
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland.
| | - Tommi Tolmunen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland.
| | - Antti-Pekka Elomaa
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
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21
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Honkalampi K, Viinamäki H, Niskanen L, Koivumaa-Honkanen H, Valkonen-Korhonen M, Elomaa AP, Harvima I, Herzig KH, Lehto SM. Reduced serum adiponectin levels in alexithymia. Neuroimmunomodulation 2014; 21:234-9. [PMID: 24603661 DOI: 10.1159/000357051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Clinical studies have demonstrated that circulating cytokine profiles may differ between alexithymic and non-alexithymic subjects. We examined whether the levels of adiponectin (μg/ml) and resistin (ng/ml) are independently related to alexithymic features in a population-based sample. METHODS In 2005, clinical data including laboratory assessments were obtained from a sub-sample (n = 308) of the Kuopio Depression Study general population study including subjects aged 25-64 years. Based on the Toronto Alexithymia Scale score in 1998, 1999, 2001 and 2005, a group of subjects with high alexithymic features (n = 85) was formed and compared with non-alexithymic controls (n = 206). RESULTS Serum adiponectin levels were significantly lower in subjects with alexithymic features than in non-alexithymic control subjects. No difference was found in resistin levels. Similarly, in a logistic regression model adjusted for age, gender and body mass index (BMI), lowered levels of adiponectin, but not resistin, were associated with an increased likelihood of belonging to the group with alexithymic features. Further adjustments for cardiovascular risk factors (i.e. smoking, BMI, metabolic syndrome, alcohol use, and coronary heart disease), depressive symptoms (Hamilton Depression Rating Scale with 17 items) and the use of antidepressants in addition to age and gender did not change these patterns. CONCLUSIONS Our findings suggest that a disturbed anti-inflammatory balance may characterize alexithymia. In addition, our results widen the concept of alexithymia and highlight the role of immune system alterations and stress in alexithymic individuals.
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Affiliation(s)
- Kirsi Honkalampi
- Department of Education and Psychology, University of Eastern Finland, Joensuu, Finland
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22
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Elomaa AP, Koivumaa-Honkanen H, Niskanen L, Honkalampi K, Valkonen-Korhonen M, Herzig KH, Viinamäki H, Lehto SM. Self-reported sleep disturbance is associated with elevated levels of PAI-1 in individuals with a recorded history of depressive symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:46-51. [PMID: 23911442 DOI: 10.1016/j.pnpbp.2013.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/10/2013] [Accepted: 07/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The majority of depressed individuals report insomnia. Self-reported symptoms of insomnia, in particular, more strongly predict adverse health effects than the actual measured sleep time. The physiological alterations in individuals with insomnia are complex, as both autonomic and endocrine dysfunctions are present. Plasminogen activator inhibitor (PAI)-1 is a stress-related acute-phase reactant that has also been suggested to regulate the circadian rhythm and sleep patterns. It has been suggested to contribute to both depressive symptoms and sleep disorders, although data on the relationships between these parameters are scarce. OBJECTIVE This study examined the role of self-reported sleep disturbance and its association with PAI-1 among individuals with a history of depressive symptoms. METHODS Differences in the serum levels of PAI-1 between two groups (group 1: moderate to very severe sleep disturbance, n=37; group 2: mild or no sleep disturbance, n = 90) were examined in a population-based sample of individuals with a recorded history of depressive symptoms. RESULTS Multivariate analysis controlling for potential confounding factors (age, sex, body mass index, depression severity) showed that each 1-unit increase in PAI-1 (μg/mL) increased the likelihood for belonging to the group with moderate to very severe sleep disturbance by 23% (OR = 1.23, C.I. 95% = 1.04-1.45, p = 0.016). This statistical significance remained after additional adjustments for regular smoking and the use of sleep or lipid-lowering medication. CONCLUSION Our observations may further clarify the physiological alterations related to sleep disturbance in depressive individuals. In the present study, self-reported sleep disturbance in individuals with a recorded history of depressive symptoms was associated with an elevation of PAI-1. This finding may illustrate the association of subjective sleep disturbance with sympathetic activation. Our study highlights the importance of effects of perceived sleep disturbance on individual homeostasis, and may provide potential directions for research on treatment options.
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Affiliation(s)
- Antti-Pekka Elomaa
- Department of Psychiatry, Kuopio University Hospital & University of Easterrn Finland, 70210 Kuopio, Finland.
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23
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Lehto SM, Elomaa AP, Niskanen L, Herzig KH, Tolmunen T, Viinamäki H, Koivumaa-Honkanen H, Huotari A, Honkalampi K, Valkonen-Korhonen M, Sinikallio S, Ruotsalainen H, Hintikka J. Serum adipokine levels in adults with a history of childhood maltreatment. Prog Neuropsychopharmacol Biol Psychiatry 2012; 37:217-21. [PMID: 22336057 DOI: 10.1016/j.pnpbp.2012.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/17/2012] [Accepted: 01/30/2012] [Indexed: 12/29/2022]
Abstract
Individuals with a history of childhood maltreatment present increased rates of metabolic disturbances, but the underlying mechanisms for such phenomena are poorly understood. This study examined whether the secretion of adipokines, adipocyte-derived inflammation markers closely associated with metabolic disorders, is altered in individuals with a history of childhood maltreatment. The serum levels of inflammatory markers adiponectin and resistin were measured from 147 general population participants who had a history of adverse mental symptoms, and who also reported their experiences of childhood maltreatment. Participants with experiences of childhood maltreatment (n=30) had lowered levels of serum adiponectin (p=0.007) and resistin (p=0.028). The differences in adiponectin levels persisted in multivariate modeling with adjustments for age, gender, and body mass index (OR for each 1 standard deviation decrease in the serum adiponectin level 2.65, 95% CI 1.31-5.35, p=0.007). Additional adjustments for marital status or a diagnosis of major depressive disorder, or the exclusion of individuals using NSAIDs, oral corticosteroids, or antidepressants did not alter the results. The association between resistin levels and childhood maltreatment did not remain independent in the same models. Our findings suggest that in individuals with previously reported adverse mental symptoms, a history of childhood maltreatment is independently associated with lowered levels of the anti-inflammatory marker adiponectin. This may lead to a lowered anti-inflammatory buffer capacity, which can, in turn, increase the susceptibility to physical and psychological states characterized by pronounced pro-inflammation.
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Affiliation(s)
- Soili M Lehto
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.
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Elomaa AP, Niskanen L, Herzig KH, Viinamäki H, Hintikka J, Koivumaa-Honkanen H, Honkalampi K, Valkonen-Korhonen M, Harvima IT, Lehto SM. Elevated levels of serum IL-5 are associated with an increased likelihood of major depressive disorder. BMC Psychiatry 2012; 12:2. [PMID: 22230487 PMCID: PMC3266629 DOI: 10.1186/1471-244x-12-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 01/09/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inflammatory mediators in both the peripheral circulation and central nervous system (CNS) are dysregulated in major depressive disorder (MDD). Nevertheless, relatively little is known about the role of the T-helper (Th)-2 effector cytokines interleukin (IL)-5 and IL-13 in MDD. METHODS We examined the serum levels of these cytokines and a Th-1 comparison cytokine, interferon (IFN)-γ, in 116 individuals (MDD, n = 58; controls, n = 58). RESULTS In our basic multivariate model controlling for the effects of potential confounders on the associations between MDD and the examined cytokines, each 1-unit increase in the serum IL-5 level increased the likelihood of belonging to the MDD group by 76% (OR 1.76, 95% CI 1.03-2.99, p = 0.04; model covariates: age, gender, marital status, daily smoking and alcohol use). The likelihood further increased in models additionally controlling for the effects of the use of antidepressants and NSAIDS, and a diagnosis of asthma. No such associations were detected with regard to IL-13 (OR 1.08, 95% CI 0.96-1.22, p = 0.22) or IFN-γ (OR 1.02, 95% CI 0.99-1.05, p = 0.23). CONCLUSIONS Elevated levels of IL-5, which uses the neural plasticity-related RAS GTPase-extracellular signal-regulated kinase (Ras-ERK) pathway to mediate its actions in the central nervous system (CNS), could be one of the factors underlying the depression-related changes in CNS plasticity.
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Affiliation(s)
- Antti-Pekka Elomaa
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
| | - Leo Niskanen
- Central Hospital of Central Finland, Jyväskylä, and University of Eastern Finland, Kuopio, Finland
| | - Karl-Heinz Herzig
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland,Institute of Biomedicine, Division of Physiology and Biocenter Oulu, University of Oulu, Finland
| | - Heimo Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Jukka Hintikka
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland,Department of Clinical Medicine, University of Oulu, Finland,Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland
| | | | - Minna Valkonen-Korhonen
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ilkka T Harvima
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Soili M Lehto
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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