Outcome of Surgery for Pediatric Gastroesophageal Reflux : Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients

Purpose: Clinical and endoscopic assessment of the outcome after fundoplication for pediatric gastroesophageal reflux. Basic procedures: Hospital records of 279 consecutive patients who underwent fundoplication for gastroesophageal reflux from 1991 to 2014 were reviewed. Underlying disorders, clinical and endoscopic findings, imaging studies, pH monitoring, and surgical technique were assessed. Main outcome measures were patency of fundoplication, control of symptoms and esophagitis, complications, redo operations, and predictive factors of failures. Main results: A total of 279 patients underwent 300 fundoplications (277 primaries and 23 redos). Underlying disorders in 217 (72%) patients included neurological impairment (28%) and esophageal atresia (22%). Indications for fundoplication included recalcitrant gastroesophageal reflux symptoms (44%), failure to thrive (22%), respiratory symptoms (15%), esophageal anastomotic stricture (4%), apneic spells (2%), and regurgitation (2%). Preoperative endoscopy was performed in 92% and pH monitoring in 49% of patients. Median age at primary fundoplication was 2.2 ((IQR = 0.5-7.5)) years. Fundoplication was open in 205 (74%; Nissen n=63, Boix-Ochoa n=97, Toupet n=39, and other n=6), laparoscopic in 72 (24%; Nissen n=67 and Toupet n=5), and included hiatoplasty in 73%. Clinical follow-up was a median of 3.9 (IQR = 1.2-9.9) years. Mortality related to surgery was 0.3%. Symptom control was achieved in 87% of patients, and esophagitis rate decreased from 65% to 29% (p Conclusion: The majority of patients who underwent fundoplication had an underlying disorder. Primary fundoplication provided control of symptoms in almost 90% of patients and also reduced the rate of esophagitis. Failure of primary fundoplication occurred in 15% of patients, and an underlying disorder, esophageal atresia, and hiatoplasty increased the risk of failure.Peer reviewe

Tibial Fractures in Alpine Skiing and Snowboarding in Finland : A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients

Background and Aim: Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. Materials and methods: All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. Results: There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n=215, 63%), followed by proximal tibial fractures (n=92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p Conclusion: The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults.Peer reviewe

Calibration of a solid state nuclear track detector (SSNTD) with high detection threshold to search for rare events in cosmic rays

We have investigated a commercially available polymer for its suitability as a solid state nuclear track detector (SSNTD). We identified that polymer to be polyethylene terephthalate (PET) and found that it has a higher detection threshold compared to many other widely used SSNTDs which makes this detector particularly suitable for rare event search in cosmic rays as it eliminates the dominant low Z background. Systematic studies were carried out to determine its charge response which is essential before any new material can be used as an SSNTD. In this paper we describe the charge response of PET to 129Xe, 78Kr and 49Ti ions from the REX-ISOLDE facility at CERN, present the calibration curve for PET and characterize it as a nuclear track detector

The so-called dry laser cleaning governed by humidity at the nanometer scale

Illumination with single nanosecond pulses leads to the detachment of silica particles with 250nm radii from siliconsurfaces. We identify two laser-energy dependent cleaning regimes by time-of-flight particle-scattering diagnostics. For the higher energies, the ejection of particles is produced by nanoscale ablation due to the laser field enhancement at the particle-surface interface. The damage-free regime at lower energy is shown to be governed by the residual water molecules, which are inevitably trapped on the materials. We discuss the great importance that the humidity plays on the cleaning force and on the adhesion in the experiments.Peer reviewe

No Longer Without a Reward: Do Digital Rewards Crowd Out Intrinsic Motivation of Young Children?

In the learning journey of young children, rewards are ubiquitous. Yet, psychologists and behavioral economists question the success of rewards and even claim that they displace intrinsic motivation, a phenomenon referred to as motivation crowding out. While information systems can help children learn everyday tasks, it is unclear if and when digital rewards produce motivation crowding out. Theoretically sound, empirical field studies on this topic are lacking and existing information system research on motivation crowding is limited to specific domains, not covering children’s behavior. Therefore, we aim to elicit how digital rewards influence an everyday health behavior that children learn in kindergarten – handwashing – and the underlying intrinsic motivation. We conduct a randomized controlled trial that is conceptualized in this paper. Our results will extend motivation crowding theory in the context of young children and inform the design of digital behavior change interventions

Atomic dynamics in evaporative cooling of trapped alkali atoms in strong magnetic fields

We investigate how the nonlinearity of the Zeeman shift for strong magnetic fields affects the dynamics of rf field induced evaporative cooling in magnetic traps. We demonstrate for the 87-Rb and 23-Na F=2 trapping states with wave packet simulations how the cooling stops when the rf field frequency goes below a certain limit (for the 85-Rb F=2 trapping state the problem does not appear). We examine the applicability of semiclassical models for the strong field case as an extension of our previous work [Phys. Rev. A 58, 3983 (1998)]. Our results verify many of the aspects observed in a recent $^{87}$Rb experiment [Phys. Rev. A 60, R1759 (1999)].Comment: 9 pages, RevTex, eps figures embedde

A comparative cohort study of Duhamel and Endorectal Pullthrough for Hirschsprung's Disease

Background: There are limited data available to compare outcomes between surgical approaches for Hirschsprung’s disease. Duhamel and endorectal pull-through (ERPT) are two of the most common procedures performed worldwide. // Methods: Objective outcomes were compared between contemporary cohorts (aged 4–32 years) after Duhamel or ERPT using case–control methodology. Data were collected using prospectively administered standardized questionnaires on bowel and bladder function and quality of life (Pediatric Quality of Life Inventory, Short form 36 and Gastrointestinal Quality of Life Index). Patients were compared in two age groups (18 years and younger and older than 18 years) and reference made to normative control data. Multivariable analysis explored factors associated with poor outcomes. // Results: Cohorts were well matched by demographics, disease characteristics and incidence of postoperative complications (120 patients who underwent Duhamel versus 57 patients who had ERPT). Bowel function scores were similar between groups. Patients who underwent Duhamel demonstrated worse constipation and inferior faecal awareness scores (P < 0.01 for both age groups). Recurrent postoperative enterocolitis was significantly more common after ERPT (34 versus 6 per cent; odds ratio 15.56 (95 per cent c.i. 6.19 to 39.24; P < 0.0001)). On multivariable analysis, poor bowel outcome was the only factor significantly associated with poor urinary outcome (adjusted odds ratio 6.66 (95 per cent c.i. 1.74 to 25.50; P = 0.006)) and was significantly associated with markedly reduced quality of life (QoL) in all instruments used (P < 0.001 for all). There were no associations between QoL measures and pull-through technique. // Conclusion: Outcomes from Duhamel and ERPT are good in the majority of cases, with comparable bowel function scores. Constipation and impaired faecal awareness were more prevalent after Duhamel, with differences sustained in adulthood. Recurrent enterocolitis was significantly more prevalent after ERPT. Clustering of poor QoL and poor functional outcomes were observed in both cohorts, with seemingly little effect by choice of surgical procedure in terms of QoL

The Barnacle Goose (Branta leucopsis) in the archipelago of southern Finland - population growth and nesting dispersal

We studied the population growth and expansion of Barnacle Goose (Branta leucopsis) in Helsinki archipelago, southern Finland. Barnacle Goose breeding was first recorded in Helsinki in 1989. During our study 1996-2013 the number of nesting geese increased from 24 to 740 pairs. We analyzed the role of protected islands in the population growth, and the factors behind differences in growth rates. Our study data consisted of 104 islands. Of these, 29 are protected from private recreational activity (nature reserve ormilitary areas) and were established prior to the start of our study. We predicted that protected areas would have a positive impact on Barnacle Goose population growth. In part of the study period (2002-2013) the population growth in our study area was much steeper in protected islands compared to islands with open access. However, breeding densities in those unprotected islands were higher than in protected islands in the early years of the study. We found that the most important factors affecting pair numbers in islands are island size and the time it has been inhabited, in addition to island distance from the islands southeast of Helsinki, where breeding expansion started. Island protection had no effect on the breeding geese numbers or current densities on the islands. Results indicate that early breeders like Barnacle Geese do not benefit from island protection probably because the recreational use of the islands is scant early in the spring.Peer reviewe

Incidence and long-term outcomes of surgically treated childhood hepatic malignancies in Finland

Aim To analyse incidence, treatment and outcomes of paediatric liver malignancies in Finland during 1987-2017. Methods Medical records and national cancer registry data of 47 children with liver malignancies were reviewed. Survival was calculated with the Kaplan-Meier method. Results During follow-up, liver malignancy incidence remained stable at 1.1:10(6). Altogether, 42 patients with hepatoblastoma (n = 24), hepatocellular carcinoma (n = 11) and undifferentiated embryonal sarcoma (n = 7) underwent surgery at median age 4.6 (interquartile range, 2.0-9.6) years and were followed up for 13 (7.0-19) years. Cumulative 5-year survival was 86% for hepatoblastoma, 41% for hepatocellular carcinoma and 67% for undifferentiated embryonal sarcoma. Five-year survival was decreased among hepatoblastoma patients aged >= 2.4 years (73% versus 100%, P = .040), with PRETreatment EXTent of disease IV (PRETEXT, 60% vs 100%, P = .004), and with recurrent disease (67% vs 88%, P = .029). Recurrent/residual disease associated with decreased 5-year survival in hepatocellular carcinoma (0% vs 83%, P = .028). Survival was similar among 19 transplanted and 23 resected patients. In total, 14 deaths occurred either for the underlying malignancy (n = 8), adverse effects of chemotherapy (n = 5) or unrelated reasons (n = 1). Conclusion Outcomes for PRETEXT I-III hepatoblastoma and un-metastasized hepatocellular carcinoma were encouraging. Adverse effects of chemotherapy significantly contributed to mortality.Peer reviewe