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  1. Article ; Online: Acute Mesenteric Ischemia: A Challenge for the Acute Care Surgeon.

    Kärkkäinen, J M

    Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

    2021  Volume 110, Issue 2, Page(s) 150–158

    Abstract: Acute mesenteric ischemia is considered uncommon, but it appears to be more frequent cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in elderly patients. Surgical treatment without revascularization is associated with high ... ...

    Abstract Acute mesenteric ischemia is considered uncommon, but it appears to be more frequent cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in elderly patients. Surgical treatment without revascularization is associated with high overall mortality, up to 80%. The modern treatment of acute mesenteric ischemia requires collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. Early revascularization may reduce the overall mortality associated with acute mesenteric ischemia by up to 50%. Clinical suspicion and contrast-enhanced computed tomography performed at early stage are keys to improve outcomes of acute mesenteric ischemia treatment. This review summarizes what the acute care surgeon needs to know about acute mesenteric ischemia with special emphasis on slowly progressing "acute on chronic" mesenteric ischemia.
    MeSH term(s) Acute Disease ; Aged ; Aortic Rupture ; Humans ; Ischemia/diagnostic imaging ; Ischemia/etiology ; Mesenteric Ischemia/diagnostic imaging ; Mesenteric Ischemia/etiology ; Surgeons ; Vascular Surgical Procedures
    Language English
    Publishing date 2021-04-19
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2077691-3
    ISSN 1799-7267 ; 1457-4969
    ISSN (online) 1799-7267
    ISSN 1457-4969
    DOI 10.1177/14574969211007590
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Technical success, clinical efficacy, and insight into the causes of restenosis after the percutaneous coronary intervention of

    Tervo, Jerry / Kärkkäinen, Jussi M / Rissanen, Tuomas T

    Frontiers in cardiovascular medicine

    2022  Volume 9, Page(s) 1012473

    Abstract: Objectives: The aim of this all-comers registry study was to investigate the technical success, clinical efficacy, and safety of a drug-coated balloon (DCB) with paclitaxel combined with citrate ester excipient (CEE) in percutaneous coronary ... ...

    Abstract Objectives: The aim of this all-comers registry study was to investigate the technical success, clinical efficacy, and safety of a drug-coated balloon (DCB) with paclitaxel combined with citrate ester excipient (CEE) in percutaneous coronary intervention (PCI) of
    Materials and methods: A total of 338 consecutive PCIs using the DCB (CEE)-only approach comprising 406
    Results: The mean follow-up time was 25 ± 12 months. The mean age of patients was 71 ± 11 years, and 48% had the acute coronary syndrome. A total of 55% of the patients were at risk of factor bleeding. The delivery of DCB was successful in 98% of cases. The overall technical success rate was 83%. Bailout stenting was used in 9% of lesions. Rotational atherectomy was used in 11% of cases before the DCB-only approach. The mean diameter of the DCBs used was 2.7 ± 0.5 mm and 38% of DCBs were large (≥3.0 mm). The 12-month MACE rates were 5.4 ± 1.7 and 18.3 ± 3.1% in stable CAD and in ACS, respectively. The respective target lesion revascularization (TLR) rates were 3.0 ± 1.3 and 8.5 ± 2.3%. Unacceptable acute recoil (>30%) was found in 74% of cases that needed repeat revascularization. No acute vessel closures occurred after DCB treatment.
    Conclusion: The DCB-only strategy using a paclitaxel-coated (CEE) device was technically feasible, safe, and effective in an all-comers population. Acute recoil was found as a significant cause of restenosis after the DCB-only strategy.
    Language English
    Publishing date 2022-10-31
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2781496-8
    ISSN 2297-055X
    ISSN 2297-055X
    DOI 10.3389/fcvm.2022.1012473
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Acute mesenteric ischemia in elderly patients.

    Kärkkäinen, J M

    Expert review of gastroenterology & hepatology

    2016  Volume 10, Issue 9, Page(s) 985–988

    MeSH term(s) Acute Disease ; Age Factors ; Aged ; Aged, 80 and over ; Chronic Disease ; Early Diagnosis ; Humans ; Mesenteric Ischemia/diagnosis ; Mesenteric Ischemia/epidemiology ; Mesenteric Ischemia/physiopathology ; Mesenteric Ischemia/therapy ; Mesenteric Vascular Occlusion/diagnosis ; Mesenteric Vascular Occlusion/epidemiology ; Mesenteric Vascular Occlusion/physiopathology ; Mesenteric Vascular Occlusion/therapy ; Middle Aged ; Predictive Value of Tests ; Risk Factors ; Treatment Outcome
    Language English
    Publishing date 2016-09
    Publishing country England
    Document type Editorial
    ZDB-ID 2481021-6
    ISSN 1747-4132 ; 1747-4124
    ISSN (online) 1747-4132
    ISSN 1747-4124
    DOI 10.1080/17474124.2016.1212657
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Enhancing identification of nonaffective psychosis in register-based studies.

    Holm, Minna / Suokas, Kimmo / Liukko, Emmi / Lindgren, Maija / Näätänen, Petri / Kärkkäinen, Jukka / Salokangas, Raimo K R / Suvisaari, Jaana

    Schizophrenia (Heidelberg, Germany)

    2024  Volume 10, Issue 1, Page(s) 20

    Abstract: The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. ... ...

    Abstract The Finnish Quality of Psychosis Care Register assesses nonaffective psychosis (NAP) care, acknowledging treatment outside specialized psychiatric services. This approach, while providing a holistic view, raises concerns about diagnostic inaccuracies. Here, we studied situations where the register-based diagnosis might be inaccurate, and whether the first episode can be reliably identified using a 14-year wash-out period. People with first register-based NAP (ICD-10 F20-F29) between years 2010 and 2018 and without NAP diagnoses in 1996-2009 were identified from the Care Register for Health Care. A diagnosis of NAP was deemed unreliable before age 7, when dementia preceded NAP diagnosis, and when a NAP diagnosis had been assigned at admission or during psychiatric hospitalization but was not confirmed by discharge diagnosis. Despite a 14-year follow-back the first register diagnosis may miss the first treatment episode in older patients. Register-based studies on psychotic disorders should pay attention to exclusion criteria and to the definition of treatment onset.
    Language English
    Publishing date 2024-02-19
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 3133210-9
    ISSN 2754-6993 ; 2754-6993
    ISSN (online) 2754-6993
    ISSN 2754-6993
    DOI 10.1038/s41537-024-00444-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Sickness absence transitions among Swedish twins with back, neck or shoulder pain and common mental disorders applying a multi-state approach.

    Kärkkäinen, Sanna / Bergström, Jakob / Ropponen, Annina / Wang, Mo / Narusyte, Jurgita / Svedberg, Pia

    Scientific reports

    2023  Volume 13, Issue 1, Page(s) 10520

    Abstract: We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences ... ...

    Abstract We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences on the transitions. Swedish twins born 1935-1985 who responded to pain and CMDs survey items (N = 41,516) were followed on average 8.7 years for sickness absence states in national registers. Multi-state Cox regression models were applied for three exposure groups: pain, CMDs, and presence of both, compared to unexposed. Exposure discordant twin pairs, stratified by zygosity, were analysed to assess the role of familial factors. Hazard Ratios (HR) with 95% confidence intervals and transition intensities were calculated. HRs were similar for transitions between states among those with pain or CMDs. The highest HRs were for transitions from entry to sickness absence and sickness absence to disability pension among those with both pain and CMDs (HRs: 1.61 and 1.43, respectively). Higher HRs for dizygotic compared to monozygotic twins for the first transition to sickness absence and for altering back to not being sickness absent indicate familial confounding. Back, neck, or shoulder pain and/or CMDs indicate a higher risk to become sickness absent and for repeated sickness absence episodes over time compared to unaffected.
    MeSH term(s) Humans ; Shoulder Pain/epidemiology ; Sweden/epidemiology ; Twins, Monozygotic ; Neck ; Mental Disorders/epidemiology
    Language English
    Publishing date 2023-06-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-023-37572-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Long-term outcome after implementation of endovascular-first strategy to treat acute mesenteric ischemia.

    Pengermä, Pasi / Venesmaa, Sari / Karjalainen, Jari / Ukkonen, Mika / Saari, Petri / Kärkkäinen, Jussi M

    Journal of vascular surgery

    2023  Volume 78, Issue 6, Page(s) 1524–1530

    Abstract: Objective: To evaluate the rationale of an aggressive endovascular-first strategy to treat elderly patients with acute mesenteric ischemia (AMI) by studying long-term survival, readmissions, and patients' discharge to home vs nursing facility a decade ... ...

    Abstract Objective: To evaluate the rationale of an aggressive endovascular-first strategy to treat elderly patients with acute mesenteric ischemia (AMI) by studying long-term survival, readmissions, and patients' discharge to home vs nursing facility a decade after an episode of AMI.
    Methods: The retrospective study cohort included 66 consecutive patients (all-comers) treated for arterial occlusive AMI between 2009 and 2013. Endovascular revascularization (EVR) was attempted in 50 patients (EVR+), whereas 16 patients were treated without attempted revascularization (EVR-). All patients were followed until death or September 2022. Studied outcomes included discharge status, long-term survival and cause of death and readmissions related to AMI.
    Results: The mean age of all 66 patients was 78 ± 10 years: 79 ± 9 years in the EVR+ group and 76 ± 12 years in the EVR- group. EVR was technically successful in 44 patients (88%); three patients underwent subsequent open revascularization after EVR failure. One-third required bowel resection after EVR. The 30-day mortality for all patients was 44%; 32% in the EVR+ group and 81% in the EVR- group. Only two survivors were permanently institutionalized, whereas all others were discharged to the same place they lived prior to the AMI episode. There were four AMI-related readmissions during the follow-up; all were in the EVR+ group. Two patients underwent reinterventions for recurrent AMI. One-year survival was 52% for EVR+ and 19% for EVR- patients. Five-year survival rates were 18% and 13%, respectively. The causes of deaths were mesenteric ischemia in 22, other cardiovascular event in 21, and non-cardiovascular cause in 19 patients. Four patients were alive at the end of the follow-up.
    Conclusions: In this unselected elderly population with AMI, the aggressive strategy to attempt EVR resulted in a high revascularization rate and favorable outcomes. The high proportion of patients returning to their prior living status and low readmission rate after survival from AMI encourages active treatment of high-functioning elderly patients.
    MeSH term(s) Humans ; Aged ; Aged, 80 and over ; Mesenteric Ischemia/diagnostic imaging ; Mesenteric Ischemia/surgery ; Endovascular Procedures/adverse effects ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Time Factors ; Ischemia/surgery
    Language English
    Publishing date 2023-08-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2023.08.100
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Percutaneous coronary intervention with drug-coated balloon-only strategy combined with single antiplatelet treatment in patients at high bleeding risk: Single center experience of a novel concept.

    Räsänen, Alma / Kärkkäinen, Jussi M / Eranti, Antti / Eränen, Jaakko / Rissanen, Tuomas T

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2023  Volume 101, Issue 3, Page(s) 569–578

    Abstract: Objectives: At least 1 month of dual antiplatelet therapy is required after coronary stenting. The aim of this all-comers retrospective registry study was to assess the efficacy and safety of percutaneous coronary intervention (PCI) using drug-coated ... ...

    Abstract Objectives: At least 1 month of dual antiplatelet therapy is required after coronary stenting. The aim of this all-comers retrospective registry study was to assess the efficacy and safety of percutaneous coronary intervention (PCI) using drug-coated balloon (DCB) with single antiplatelet treatment (SAPT).
    Methods: Between 2011 and 2020, 232 PCIs were performed in 172 patients using the DCB-only strategy and discharged with SAPT.
    Results: The mean age of the patients was 75 ± 11 years and 59% were male. The clinical presentation was stable coronary artery disease (CAD) in 42% of the patients and acute coronary syndrome (ACS) in 58%. The lesions were mainly de novo (96%). The majority (58%) of treated lesions were in large coronary arteries (≥3.0 mm). Most (87%) of the patients were at high bleeding risk (HBR) with at least one major or two minor Academic Research Consortium (ARC) risk factors for bleeding. Periprocedural DAPT was used in 49% of the patients. The 12-month major adverse cardiac events (MACE, the composition of cardiovascular death, nonfatal myocardial infarction, and target-lesion revascularization) rate was 1.4% in stable CAD and 7.1% in ACS. The 12-month all-cause mortality after DBC only + SAPT strategy was 4.1% in stable CAD and 12.1% in ACS. The rate of ischemia-driven target lesion revascularisation (TLR) was 0% in stable CAD and 3.0% in ACS at 12 months. The 12-month rate of significant bleeding (BARC type 2-5) was 10.5%. There were no acute or subacute vessel closures.
    Conclusions: Despite the aged patient population with comorbidities, the TLR, MACE, and bleeding rates were low with DCB-only PCI combined with SAPT. This novel approach could reduce the post-PCI bleeding risk in patients with CAD and HBR compared to stenting.
    MeSH term(s) Humans ; Male ; Aged ; Middle Aged ; Aged, 80 and over ; Female ; Percutaneous Coronary Intervention/adverse effects ; Retrospective Studies ; Treatment Outcome ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Coronary Artery Disease/etiology ; Hemorrhage/chemically induced ; Acute Coronary Syndrome/diagnostic imaging ; Acute Coronary Syndrome/therapy ; Platelet Aggregation Inhibitors/adverse effects
    Chemical Substances Platelet Aggregation Inhibitors
    Language English
    Publishing date 2023-01-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.30558
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  8. Article: Western Diet Decreases Hepatic Drug Metabolism in Male LDLr

    Koponen, Markus / Rysä, Jaana / Ruotsalainen, Anna-Kaisa / Kärkkäinen, Olli / Juvonen, Risto O

    Journal of nutrition and metabolism

    2023  Volume 2023, Page(s) 5599789

    Abstract: Consumption of a Western diet is an important risk factor for several chronic diseases including nonalcoholic fatty liver disease (NAFLD), but its effect on the xenobiotic metabolizing enzyme activities in the liver has been studied incompletely. In this ...

    Abstract Consumption of a Western diet is an important risk factor for several chronic diseases including nonalcoholic fatty liver disease (NAFLD), but its effect on the xenobiotic metabolizing enzyme activities in the liver has been studied incompletely. In this study, male LDLr
    Language English
    Publishing date 2023-03-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2573563-9
    ISSN 2090-0732 ; 2090-0724
    ISSN (online) 2090-0732
    ISSN 2090-0724
    DOI 10.1155/2023/5599789
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Three-dimensional Laparoscopy (3D-LC)

    Eskelinen, Maaret / Saimanen, Iina / Selander, Tuomas / Kärkkäinen, Jari / Juvonen, Petri / Aspinen, Samuli / Eskelinen, Matti

    In vivo (Athens, Greece)

    2022  Volume 36, Issue 6, Page(s) 2835–2839

    Abstract: Background/aim: Three-dimensional laparoscopy (3D-Lap) is a recent innovation in surgery. The 3D-Lap is rarely used in cholecystectomy (3D-LC) and there are no prospective studies assessing advantages and disadvantages of 3D-LC versus minilaparotomy (MC) ...

    Abstract Background/aim: Three-dimensional laparoscopy (3D-Lap) is a recent innovation in surgery. The 3D-Lap is rarely used in cholecystectomy (3D-LC) and there are no prospective studies assessing advantages and disadvantages of 3D-LC versus minilaparotomy (MC) in cholecystectomy.
    Patients and methods: This was a prospective clinical study conducted in the Kuopio University Hospital, including 200 patients with symptomatic cholelithiasis who were randomized into 3D-LC (n=112) or MC (n=88) groups. The numeric rating scale (NRS) pain score and number of analgesic doses (NAD) following surgery were documented.
    Results: Similar low postoperative pain scores were reported in the 3D-LC and MC groups during the first hours following surgery, although the 3D-LC patients reported lower NRS pain score (p<0.05) one hour postoperatively. Interestingly, the 3D-LC patients showed significantly less pain 24 hours following surgery, the mean of NRS of 0-10 score at rest being 1.2 in the 3D-LC group versus 2.2 in the MC group (p<0.001), and the pain at the quick movement/coughing, the mean NRS being 2.9 in the 3D-LC group versus 3.6 in the MC group (p=0.05).
    Conclusion: The 3D-LC patients reported significantly lower pain scores 24 hours postoperatively than MC patients. However, the patient experience of pain depends on many factors and our results suggest that both 3D-LC and MC are safe and efficient techniques for cholecystectomy.
    MeSH term(s) Humans ; Laparotomy/methods ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Cholecystectomy/methods ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Laparoscopy
    Language English
    Publishing date 2022-10-07
    Publishing country Greece
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 807031-3
    ISSN 1791-7549 ; 0258-851X
    ISSN (online) 1791-7549
    ISSN 0258-851X
    DOI 10.21873/invivo.13022
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  10. Article ; Online: Pregnane X receptor activation remodels glucose metabolism to promote NAFLD development in obese mice.

    Karpale, Mikko / Kummu, Outi / Kärkkäinen, Olli / Lehtonen, Marko / Näpänkangas, Juha / Herfurth, Uta M / Braeuning, Albert / Rysä, Jaana / Hakkola, Jukka

    Molecular metabolism

    2023  Volume 76, Page(s) 101779

    Abstract: Objective: Both obesity and exposure to chemicals may induce non-alcoholic fatty liver disease (NAFLD). Pregnane X Receptor (PXR) is a central target of metabolism disrupting chemicals and disturbs hepatic glucose and lipid metabolism. We hypothesized ... ...

    Abstract Objective: Both obesity and exposure to chemicals may induce non-alcoholic fatty liver disease (NAFLD). Pregnane X Receptor (PXR) is a central target of metabolism disrupting chemicals and disturbs hepatic glucose and lipid metabolism. We hypothesized that the metabolic consequences of PXR activation may be modified by existing obesity and associated metabolic dysfunction.
    Methods: Wildtype and PXR knockout male mice were fed high-fat diet to induce obesity and metabolic dysfunction. PXR was activated with pregnenolone-16α-carbonitrile. Glucose metabolism, hepatosteatosis, insulin signaling, glucose uptake, liver glycogen, plasma and liver metabolomics, and liver, white adipose tissue, and muscle transcriptomics were investigated.
    Results: PXR activation aggravated obesity-induced liver steatosis by promoting lipogenesis and inhibiting fatty acid disposal. Accordingly, hepatic insulin sensitivity was impaired and circulating alanine aminotransferase level increased. Lipid synthesis was facilitated by increased liver glucose uptake and utilization of glycogen reserves resulting in dissociation of hepatosteatosis and hepatic insulin resistance from the systemic glucose tolerance and insulin sensitivity. Furthermore, glucagon-induced hepatic glucose production was impaired. PXR deficiency did not protect from the metabolic manifestations of obesity, but the liver transcriptomics and metabolomics profiling suggest diminished activation of inflammation and less prominent changes in the overall metabolite profile.
    Conclusions: Obesity and PXR activation by chemical exposure have a synergistic effect on NAFLD development. To support liver fat accumulation the PXR activation reorganizes glucose metabolism that seemingly improves systemic glucose metabolism. This implies that obese individuals, already predisposed to metabolic diseases, may be more susceptible to harmful metabolic effects of PXR-activating drugs and environmental chemicals.
    MeSH term(s) Mice ; Animals ; Male ; Non-alcoholic Fatty Liver Disease ; Pregnane X Receptor ; Mice, Obese ; Insulin Resistance ; Obesity/metabolism ; Glucose/metabolism
    Chemical Substances Pregnane X Receptor ; Glucose (IY9XDZ35W2)
    Language English
    Publishing date 2023-07-17
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2708735-9
    ISSN 2212-8778 ; 2212-8778
    ISSN (online) 2212-8778
    ISSN 2212-8778
    DOI 10.1016/j.molmet.2023.101779
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