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Research indicates that adolescent psychological symptoms are associated with subsequent mental health disorders. Studies also show the association of leisure activity with improved current and future mental health. However, research is limited on whether social leisure time activity is a mediating link in the association between psychological symptoms and later psychiatric morbidity. We examined whether adolescence-related social leisure time activity, per se, is a mediating link in the association between adolescent psychological symptoms and later psychiatric morbidity. The study population was based on the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6709; 3227 males). Psychological symptoms at age 15–16 years were measured with the Youth Self Report (YSR) questionnaire. Study participants’ psychiatric morbidity by the age of 33 years was assessed using the diagnoses from the nationwide health care registers. Our results showed an association between psychological symptoms and leisure time activities that varied depending on the level of social activity. Leisure time activity was found to be a mediating link between psychological symptoms in adolescence and psychiatric disorders in early adulthood. Adolescence-related leisure time activities, which differed with regard to social interactions, appeared to serve as a mediating link between adolescent psychological symptoms and later onset of psychiatric disorders. Socially active leisure time during adolescence is related to better long-term mental health, while socially inactive leisure time associates with the likelihood of later psychiatric morbidity. To prevent psychiatric disorders, enhancing such leisure time activities in society is highly recommended.

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making., + ID der Publikation: hslu_97752 + Art des Beitrages: Wissenschaftliche Medien + Jahrgang: 12 + Sprache: Englisch + Letzte Aktualisierung: 2023-07-10 16:04:23

Additional file 2: Fig. S1. Representative images of thrombus in the saccular intracranial aneurysm (sIA) presenting immunohistochemical staining for LYVE-1 (A), podoplanin (B), VEGFR-3 (C), and Prox1 (D). Ring-shaped structures of immunohistochemical staining positive for LYVE-1 (E) and podoplanin (F), i.e., lymphatic vessels, in the sIA thrombus. The negative controls are shown as insets. Black arrows point down towards the lumen. Scale bar: 50 μm. Positive staining is brown. Haematoxylin background staining.

Additional file 1: Table S1.

Population aging is likely increasing the number of surgically treated very old (>= 80-year-old) intracranial meningioma (IM) patients. Since there is little data on mortality in this patient group, we studied whether survival of surgically treated very old IM patients differs from survival of a matched general population. We retrospectively identified 83 consecutive very old IM patients (median age 83 years; 69% women) operated between 2010 and 2018. During the first postoperative year, operated IM patients suffered 2.5 times higher mortality as compared to age- and sex-matched general population but no annual survival difference occurred thereafter. Regarding cumulative estimates, no excess mortality was detected after the second postoperative year. Of the patient who were and who were not able to live at home preoperatively, 78% and 42% lived at home within 3 months, respectively. Preoperative loss of capability to live at home associated with a less frequent return to home [odds ratio (95% confidence interval) 0.21 (0.06-0.67)]. Operated very old IM patients had short-term excess mortality but similar cumulative survival as the matched general population. Moreover, most patients returned home soon after surgery.

Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage, a severe type of stroke. To discover new risk loci and the genetic architecture of intracranial aneurysms, we performed a cross-ancestry, genome-wide association study in 10,754 cases and 306,882 controls of European and East Asian ancestry. We discovered 17 risk loci, 11 of which are new. We reveal a polygenic architecture and explain over half of the disease heritability. We show a high genetic correlation between ruptured and unruptured intracranial aneurysms. We also find a suggestive role for endothelial cells by using gene mapping and heritability enrichment. Drug-target enrichment shows pleiotropy between intracranial aneurysms and antiepileptic and sex hormone drugs, providing insights into intracranial aneurysm pathophysiology. Finally, genetic risks for smoking and high blood pressure, the two main clinical risk factors, play important roles in intracranial aneurysm risk, and drive most of the genetic correlation between intracranial aneurysms and other cerebrovascular traits.

Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. Devastating post-SAH complications, such as cerebral vasospasm (CVS), delayed cerebral ischemia or seizures to mention a few, are mainly responsible for the poor clinical outcome. Inflammation plays an indispensable role during early brain injury (EBI) and delayed brain injury (DBI) phases over which these complications arise. T helper cells are the major cytokine secreting cells of adaptive immunity that can polarize to multiple functionally unique sub-populations. Here, we investigate different CD4+ T cell subsets during EBI and DBI phases after SAH, and their dynamics during post-SAH complications. Peripheral venous blood from 15 SAH patients during EBI and DBI phases, was analyzed by multicolour flowcytometry. Different subsets of CD3+ CD4+ T cells were characterized by differential cell surface expression of CXCR3 and CCR6 into Th1, Th2, Th17, whereas Tregs were defined by CD25hiCD127lo. The analysis of activation states was done by the expression of stable activation markers CD38 and HLA-DR. Interestingly, compared to healthy controls, Tregs were significantly increased during both EBI and DBI phases. Different activation states of Tregs showed differential significant increase during EBI and DBI phases compared to controls. HLA-DR− CD38+ Tregs were significantly increased during DBI phase compared to EBI phase in SAH patients developing CVS, seizures and infections. However, HLA-DR− CD38− Tregs were significantly reduced during EBI phase in patients with cerebral ischemia (CI) compared to those without CI. HLA-DR− CD38− Th2 cells were significantly increased during EBI phase compared to controls. A significant reduction in Th17/Tregs and HLA-DR− CD38+ Th17/Tregs ratios was observed during both EBI and DBI phases compared to controls. While HLA-DR− CD38− Th17/Tregs and HLA-DR− CD38− Th1/Th2 ratios were impaired only during EBI phase compared to controls. In conclusion, CD4+ T cell subsets display dynamic and unique activation patterns after SAH and during the course of the manifestation of post-SAH complications, which may be helpful for the development of precision neurovascular care. However, to claim this, confirmatory studies with larger patient cohorts, ideally from different ethnic backgrounds, are required. Moreover, our descriptive study may be the grounds for subsequent lab endeavors to explore the underlying mechanisms of our observations.

In the version of this article initially published, the following statement was missing from the Acknowledgements: “We are grateful to the GenoBiRD core facility (Biogenouest), the Clinical Investigation Center (INSERM CIC1413) and the Center of Biological Resources in Nantes (BB-0033-00040; CHU Nantes, France) for their assistance in managing and genotyping the ICAN and PREGO biobanks. R.R. was supported by the French Regional Council of Pays-de-la-Loire (VaCaRMe program) and the Agence Nationale de la Recherche (ANR-15-CE17-0008-01 to G.L). H.D. and R.B. were supported by the French Ministry of Health (clinical trial NCT02848495 to H.D.), the Genavie Foundation, the Société Française de Radiologie and the Société Française de Neuroradiologie.” The error has been corrected in the HTML and PDF versions of the article. *Lists of authors and their affiliations appear online. Korrektur zu 10.1038/s41588-020-00725-7

Supplemental material, spub-ri-2017-0355-File005_supplementary for Association between parental hospital-treated somatic illnesses in childhood and later mental disorders among offspring up to early adulthood: An explorative study in the 1987 Finnish Birth Cohort by Marko Merikukka, Sami Räsänen, Helinä Hakko, Tiina Ristikari, Mika Gissler, Mika Niemelä in Scandinavian Journal of Public Health

Objective: To investigate whether parental TBI increases the overall risk for psychiatric disorders and the risk for specific psychiatric diagnoses in the children affected by parental TBI. Methods: The 1987 Finnish Birth Cohort (n = 59 476) were followed up through national registers from birth to the end of 2008. The diagnoses of cohort members and their parents were obtained from the Care Register of Health Care, provided by the National Institute of Health and Welfare. Results: During the 21-year follow-up, the likelihood for psychiatric diagnoses being assessed in psychiatric care was significantly increased in males with any mental disorder (odds ratio (OR) = 1.43), substance-use-related disorders (OR = 1.71) and behavioural and emotional disorders (OR = 1.75), and in females with disorders of psychological development (OR = 1.85). Conclusions: Children affected by parental TBI are at increased risk for psychiatric disorders: males for externalizing disorders and females for developmental disorders. Observed gender interactions in the association between parental TBI and the psychiatric disorders of children warrant further study.

Background and purposeCommon variants have been identified using genome-wide association studies which contribute to intracranial aneurysms (IA) susceptibility. However, it is clear that the variants identified to date do not account for the estimated genetic contribution to disease risk.MethodsInitial analysis was performed in a discovery sample of 2617 IA cases and 2548 controls of white ancestry. Novel chromosomal regions meeting genome-wide significance were further tested for association in 2 independent replication samples: Dutch (717 cases; 3004 controls) and Finnish (799 cases; 2317 controls). A meta-analysis was performed to combine the results from the 3 studies for key chromosomal regions of interest.ResultsGenome-wide evidence of association was detected in the discovery sample on chromosome 9 (CDKN2BAS; rs10733376: P

International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting.We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (HH), modified Rankin Scale (mRS) and Fisher classification.Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %)10 mm (mean size, 6.2 mm). In total, 112 were categorised as berry-like configured aneurysms (n = 11310 mm, n = 310 mm), 18 as multi-lobar (n = 1610 mm, n = 210 mm) and 5 as fusiform (n = 410 mm, n = 1,10 mm).Since the results of our study showed that the majority of the aneurysms are10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs.

Intracerebral haemorrhage (ICH) is a deadly subtype of stroke with an average 12-month mortality exceeding 50%. Despite advances at other frontiers of stroke treatment, treatment options for ICH are limited. Neurosurgical treatment for ICH has been discussed in recent multicentre studies, but no definitive answer of its utility has emerged. Age, ICH volume and location, and extent of ventricular haemorrhage among other factors affect the prognosis after ICH. We studied the effect of neurosurgical treatment (1) in patients with intracerebellar haemorrhage; (2) in patients with ICH-related hydrocephalus; and (3) in young adults in an observational, retrospective analysis of consecutive ICH patients admitted to Helsinki University Hospital during a five-year period. In addition, we studied the different prognostic scores for ICH to find the best tool for estimation of the risk of death after ICH. Traumatic and aneurysmal ICHs were excluded from the study. We found 19 prognostic scores, many of which were based on the original ICH score. For estimating the risk of in-hospital death, the National Institutes of Health Stroke Scale performed as well as the best dedicated scores. For 3- and 12-month mortality, the ICH Functional Outcome Scale (ICH-FOS) performed best. However, all prognostic scores share the risk of self-fulfilling prophecies, the estimated poor outcome resulting in limitations of care. Based on a mutual consensus among neurologists and neurosurgeons, cerebellar ICH is usually treated surgically in patients with a declining level of consciousness and a large haematoma. However, in our series, surgical and medical treatment did not differ in short- or long-term mortality, but surgically treated patients were left in a poor clinical condition at hospital discharge. The surgically treated patients were younger, had larger ICHs and their level of consciousness on arrival was lower than the conservatively treated patients. Although surgically treated patients were left in a poor condition, no data exist on long-term functional outcome and recovery after intracerebellar haemorrhage. ICH-related hydrocephalus is usually considered a predictor of poor outcome. In our series, hydrocephalic patients had very high mortality, but surgical treatment – either by external ventricular drainage or evacuation of a hydrocephalus-causing cerebellar ICH – was associated with lower in-hospital and 3-month mortality. Only a small subgroup of all hydrocephalic patients received surgical treatment, but a difference in mortality between surgically and conservatively treated patients was observed in a propensity-matched case-control comparison. The high mortality previously attributed to ICH-related hydrocephalus may be a self-fulfilling prophecy. ICH in the young was caused most often by hypertension and structural vascular anomalies such as arteriovenous malformations or cavernous angiomas. The predictors of poor outcome did not differ from those in older patients, these being Glasgow coma score < 8, infratentorial location, intraventricular blood, hydrocephalus, and haematoma volume > 30 ml. However, surgical treatment was associated with significantly lower mortality than conservative treatment. In conclusion, surgical treatment was associated with a lower short- and long-term mortality in patients with ICH-related hydrocephalus and in young adults. More studies are needed to elucidate the advantages and disadvantages of surgical treatment in patients with intracerebellar haemorrhage and ICH-related hydrocephalus. Aivojensisäinen verenvuoto on äkillinen ja tappava sairaus, johon sairastuneista yli puolet menehtyy vuoden sisällä. Vuodon tavallisimpia syitä ovat hitaasti kehittyvät rappeumamuutokset aivojen pienissä valtimoissa esimerkiksi verenpainetaudin seurauksena ja veren hyytymiseen vaikuttavat lääkkeet. Aivojen sisällä verihyytymä vaurioittaa aivokudosta paikallisesti repien harmaan ja valkean aineen hermoratoja, kun taas veren aiheuttama kemiallinen ärsytys ja painevaikutus aiheuttavat lisävaurioita sitä ympäröiviin rakenteisiin. Aivojensisäisen verenvuodon ennuste riippuu vuodon sijainnin ja koon lisäksi potilaan iästä, taustasairauksista ja aiemmasta lääkityksestä. Ennusteen arviointiin on kehitetty lukuisia pisteytysmalleja. Leikkaushoidon vaikutusta kuolleisuuteen on aiemmin selvitetty laajoissa satunnaistetuissa monikeskustutkimuksissa, eikä kiistatonta näyttöä sen hyödyistä ole saatu. Leikkaushoitoa kuitenkin harkitaan nuorilla potilailla sekä silloin, kun hyytymä sijaitsee pikkuaivoissa ja painaa aivorunkoa tai tukkii aivo-selkäydinnestekierron. Tässä väitöskirjassa tutkittiin aivojensisäisen verenvuodon hoitotuloksia Helsingin yliopistollisessa keskussairaalassa vuosina 2005-2010 yli tuhannen potilaan aineistossa, keskittyen kirurgisesti hoidettuihin potilasryhmiin: pikkuaivovuodon saaneisiin potilaisiin, nuoriin aikuispotilaisiin ja niihin, joille kehittyi vuodon seurauksena aivo-selkäydinnestekierron häiriö eli hydrokefalus. Lisäksi tutkimme, mikä olemassa olevista 19 pisteytysmallista ennustaa parhaiten vuodonjälkeistä kuolleisuutta. Kyseessä oli takautuva asiakirjatutkimus. Totesimme, että pikkuaivovuodon kirurgisen hoidon tulokset olivat odotettua heikommat – leikattujen ja lääkkeellistä tuki- ja tehohoitoa saaneiden potilaiden kuolleisuus oli yhtä suurta. Leikkauksen ansiosta osa todennäköisesti jäi henkiin, mutta huonokuntoisiksi jääneiden vuodepotilaiden osuus oli leikattujen potilaiden ryhmässä merkittävästi suurempi. Tuloksemme vahvistavat viimeaikaisia havaintoja, joiden mukaan pikkuaivovuodon leikkaushoito ei ole niin hyödyllistä kuin yleensä ajatellaan. Kuolleisuus oli erittäin runsasta myös niillä potilailla, joille kehittyi vuodon seurauksena aivo-selkäydinnestekierron häiriö. Aiempien tutkimusten perusteella arvelimme, että leikkaushoito ei merkittävästi parantaisi ennustetta. Leikattujen potilaiden kuolleisuus oli kuitenkin yllättäen merkittävästi pienempää kuin lääkkeellistä teho- ja tukihoitoa saaneilla potilailla. Myös nuorten aikuispotilaiden leikkaushoito vuodon sijainnista riippumatta paransi ennustetta lääkkeellistä tuki- ja tehohoitoa saaneisiin potilaisiin verrattuna. Pisteytysmalleista totesimme, että aivoverenkiertohäiriön vaikeusasteen arviointiin tarkoitettu National Institutes of Health Stroke Scale (NIHSS) ennusti parhaiten sairaalassa tapahtuvaa kuolleisuutta, kun taas kolmen kuukauden ja vuoden kuluttua vuodosta kuolleisuutta ennusti parhaiten tähän tarkoitukseen kehitetty ICH Functional Outcome Score (ICH-FOS). Aivojensisäisen verenvuodon leikkaushoidon tulokset Helsingin yliopistollisessa keskussairaalassa olivat odotettua paremmat nuorilla aikuisilla vuodon sijainnista riippumatta sekä niillä potilailla, joilla vuoto aiheutti aivo-selkäydinnestekierron häiriön. Pikkuaivovuodon saaneilla potilailla taas leikkauksen hyödyt jäivät odotettua pienemmiksi. Hoitovaihtoehtoja tulee arvioida kaikilla aivojensisäisen verenvuodon saaneilla potilailla yksilöllisesti ja harkita leikkaushoitoa niillä potilailla, joiden toipumisennustetta se todennäköisimmin parantaa.