Medium and long-term outcomes of gastroschisis

As survival of gastroschisis patients has improved significantly, it has become apparent that longitudinal follow up strategies need to be developed. Problems concerning patients with gastroschisis are usually associated with gastrointestinal morbidity, but there is mounting evidence that also neurodevelopmental, cognitive, behavioral and late-onset auditory sequelae exist. The presence of associated anomalies, as well as complex features (bowel atresia, necrosis, volvulus, perforation) increase morbidity and impact long-term outcomes. Multidisciplinary follow-up is required, and the key elements of such follow-up are presented here. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Lapsen äkillinen vatsakipu

English summar

Kaukokartoitusperusteinen menetelmä ilman metsänkäyttöilmoitusta hakattujen uudistushakkuukohteiden valvontaan

Maaliskuussa 2013 astui voimaan Euroopan Unionin puutavara-asetus (EUTR 995/2010). Asetuksen tavoitteena on pyrkiä estämään Euroopan Unionin alueella tapahtuvaa laitonta puutavaran kauppaa ja puunkorjuuta. Asetus vaatii sekä metsänomistajan että maahantuojan käyttävän asianmukaisen huolellisuuden järjestelmää puutavaran laillisuuden takaamiseksi. Suomen kohdalla tämä merkitsee, että tuontipuun alkuperän selvittämiseksi maahantuojalla on oltava asianmukaisen huolellisuuden järjestelmä. Suomessa tuotettua puuta koskien metsänomistajan asianmukaiseksi huolellisuuden järjestelmäksi katsotaan metsänkäyttöilmoitus ja mittaustodistus hakkuusta, jossa puutavaraa on saatettu myyntiin. Maaseutuvirasto toimii asetuksen toimivaltaisena viranomaisena ja valvoo, että asetusta noudatetaan. Suomen metsäkeskuksen yksi tärkeistä lakisääteisistä tehtävistä on tarkastaa kaikki saapuvat metsänkäyttöilmoitukset. Metsäkeskus ei ole aikaisemmin systemaattisesti valvonut onko hakkuita tehty ilman metsänkäyttöilmoitusta. Tämän tutkimuksen tavoitteena on kehittää Metsäkeskukselle kaukokartoitusperusteinen menetelmä ilman metsänkäyttöilmoitusta hakattujen uudistushakkuukohteiden valvontaan. Samalla saadaan selville puuttuvien ja virheellisten metsänkäyttöilmoitusten määrä. Tutkimuksen tavoitteeseen pääsyssä hyödynnetään Metsäkeskuksen laserkeilausaineistoa, metsävaratietoa ja ilmakuvaa vuodelta 2012 sekä paikkatietoanalyysia, karttakohteiden luokitusta ja arkistojen läpikäyntiä. Tutkimustulos osoittaa, että tutkimusalueella ilman metsänkäyttöilmoitusta tehtyjä uudistushakkuita oli 2,6 % kaikista 1.7.2006–1.7.2012 välisenä aikana tehdyistä uudistushakkuista. Tuloksessa on epävarmuutta laiminlyöntien lopullisesta määrästä, koska tutkimuksessa ei kuultu maanomistajan selvitystä ilmoituksen puuttumiseen. Tältä osin tarvitaan jatkotutkimus. Voidaan todeta, että kaukokartoitusperusteinen menetelmä on käyttökelpoinen ilman metsänkäyttöilmoitusta tehtyjen uudistushakkuiden valvontaan. Menetelmän avulla saadaan mahdolliset rikkeet selville jatkotoimenpiteitä varten.In March 2013 came into effect the European Union Timber Regulation (EUTR 995/2010). The object of the Regulation is to prevent illegal trade in timber and timber harvesting inside the European Union. The Regulation will require the forest owner as well as the importer to use the system of the due diligence to ensure the legality of timber. In Finland’s case this means that in order to clarify the origin of the imported timber, the wood importer has to exercise the due diligence system. For the wood produced in Finland, the forest owner has to exercise the due diligence system including a forest use declaration and the measurement certificate of forest harvesting, in which the timber is put up for sale. The Agency for Rural affairs is the authorized public authority supervising the use of the regulation. One of the important statutory tasks of the Finnish Forest Centre is to inspect all incoming forest use declarations. The Forest Centre has not previously systematically supervised the legality of the forest harvesting made without the declaration. The objective of this research is to develop a remote sensing-based method for the Forest Centre to control the final fellings harvested without the forest use declaration. At the same time information is received about the number of missing and incorrect forest use declarations. For the objective of the research is utilized the Forest Centre’s laser scanning materials, forest resources data, aerial images, year 2012, also spatial data analysis, the classification of map objects and archives. The research result shows that in the study area, 2.6 % of all the final fellings carried out between 1.7.2006–1.7.2012 were made without the forest use declaration. In the research results there is uncertainty about the final amount of defaults, since the landowners were not consulted about the lack of declaration. For this a further research is needed. It can be seen that the method based on the remote sensing-based system is useful for controlling the final fellings harvested without the forest use declaration. The method permits to find out any violations and to take follow-up measures

Development of Late Continence in Bladder Exstrophy and Epispadias Patients

OBJECTIVE To evaluate to what extend urinary continence develops during puberty in patients with classic bladder exstrophy (CBE) and epispadias. METHODS The operative database was reviewed for surgical procedures and urinary continence in all 65 CBE and epispadias patients born in 1976-2005. Excluded were 2 patients who had insufficient data for evaluation. RESULTS Thirty-five patients with volitional voiding were incontinent at the age of 10 years, 27 had daily incontinence, and 8 had rare incontinence. Sixteen patients (46%) became later fully continent without any major surgery (except Deflux injections in 3 patients) or CIC treatment. Among these 16 fully continent patients there were 7/8 with rare incontinence, 9/23 with daily incontinence (P = .04); 3/9 males with CBE, 10/13 males with epispadias, 3/5 females with CBE, and 0/4 females with epispadias (P = .25 between sex and P =.48 between diagnosis). Of the 15 patients remaining incontinent, 10 had daily and 5 had rare incontinence episodes. The latest control was at the median age of 19 years (interquartile range 17-21 years). Twenty-five patients (40% of the whole material) were fully continent (11/38 (29%) with CBE and 14/25 (56%) with epispadias, P =.04) and 8 (13%) had rare incontinence with volitional voiding (1/38 [3%] with CBE and 7/25 [28%] with epispadias). CONCLUSION Almost half of the incontinent CBE and epispadias patients with volitional voiding achieved continence after the age of 10 without major surgery. Prognosis for pubertal development of continence was best in patients with rare incontinence and in males with epispadias. UROLOGY 144: 194-197, 2020. (c) 2020 Elsevier Inc.Peer reviewe

Editorial : Current concepts and recent advances on pediatric appendicitis

Non peer reviewe

Investigating the short- and long-term effects of antibacterial agents using a real-time assay based on bioluminescent E. coli-lux

We have previously established that the E. coli-lux assessment is a convenient tool for rapid measurements of the kinetical features of short-term toxicity caused by various factors. In this study, kinetic measurements of seven specifically acting model antibacterials (i.e., polymyxin B, chloramphenicol, nalidixic acid, kanamycin, deoxynivalenol, erythromycin and tetracycline) and two metals (AgNO3 and CdCl2) against E. coli-lux through a bioluminescence- and optical density-based real-time assay that combined short- and long-term toxicity assessments were performed. Bacteria were exposed to antibacterials and the effects were reported as the half-maximum effective concentration (EC50) after 30 min and 10 h. Regarding the 10-hour endpoints, all reference compounds, except deoxynivalenol, showed dose-response inhibition in the studied concentration range. The analysis of chloramphenicol, kanamycin, erythromycin, tetracycline and nalidixic acid clearly revealed the limitations of short-term inhibition tests. No significant differences were observed between the results obtained from luminescence inhibition and growth inhibition assays. The kinetical data from measurements provide differentiation between bacteriostatic and bactericidal mechanisms of various types of antibacterial agents. The combined assessment of short- and long-term effects reduces the risk of the underestimation of toxicity due to an inaccurate endpoint selection. The cost-efficient and fully automated E. coli-lux assessment technique may offer possibilities for high-throughput screening procedures.</p

Development of a core outcome set for congenital pulmonary airway malformations : study protocol of an international Delphi survey

Introduction A worldwide lack of consensus exists on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM) even though the incidence is increasing. Either a surgical resection is performed or a wait-and-see policy is employed, depending on the treating physician. Management is largely based on expert opinion and scientific evidence is scarce. Wide variations in outcome measures are seen between studies making comparison difficult thus highlighting the lack of universal consensus in outcome measures as well. We aim to define a core outcome set which will include the most important core outcome parameters for paediatric patients with an asymptomatic CPAM. Methods and analysis This study will include a critical appraisal of the current literature followed by a three-stage Delphi process with two stakeholder groups. One surgical group including paediatric as well as thoracic surgeons, and a non-surgeon group including paediatric pulmonologists, intensive care and neonatal specialists. All participants will score outcome parameters according to their level of importance and the most important parameters will be determined by consensus. Ethics and dissemination Electronic informed consent will be obtained from all participants. Ethical approval is not required. After the core outcome set has been defined, we intend to design an international randomised controlled trial: the COllaborative Neonatal NEtwork for the first CPAM Trial, which will be aimed at determining the optimal management of patients with asymptomatic CPAM.Peer reviewe

Henkitorviavanne lapsella

VertaisarvioituTrakeostomia eli henkitorviavanteen teko on lapsella hengitystieongelmien hoidon äärimuoto. Sen tarve on harkittava tarkasti huomioiden lapsen sairaudet, kokonaistilanne ja mahdollisuus hoitoon ¬yksikössä, jossa hoidosta on tarpeeksi kokemusta. Toimenpiteen yleisimpiä syitä ovat kasvojen rakennepoikkeavuudet, hengitysteiden ahtaumat ja keuhkoputken vaikea pehmeys. Kotiin pyritään järjestämään hoitorinki ympärivuorokautisen hoidon varmistamiseksi.Peer reviewe

Ankle and knee extensor muscle effort during locomotion in young and older athletes : Implications for understanding age-related locomotor decline

Age-related reduction in muscle force generation capacity is similarly evident across different lower limb muscle groups, yet decline in locomotor performance with age has been shown to depend primarily on reduced ankle extensor muscle function. To better understand why ageing has the largest detrimental effect on ankle joint function during locomotion, we examined maximal ankle and knee extensor force development during a two-leg hopping test in older and young men, and used these forces as a reference to calculate relative operating efforts for the knee and ankle extensors as participants walked, ran and sprinted. We found that, across locomotion modes in both age groups, ankle extensors operated at a greater relative effort compared to knee extensors; however, slightly less pronounced differences between ankle and knee extensor muscle efforts were present among older men, mainly due to a reduction in the ankle extensor force generation during locomotion modes. We consider these findings as evidence that reduced ankle push-off function in older age is driven by a tendency to keep ankle extensor effort during locomotion lower than it would otherwise be, which, in turn, may be an important self-optimisation strategy to prevent locomotor-induced fatigue of ankle extensor muscles.Peer reviewe