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

Resonant Absorption in GaAs-Based Nanowires by Means of Photo-Acoustic Spectroscopy

Semiconductor nanowires made of high refractive index materials can couple the incoming light to specific waveguide modes that offer resonant absorption enhancement under the bandgap wavelength, essential for light harvesting, lasing and detection applications. Moreover, the non-trivial ellipticity of such modes can offer near field interactions with chiral molecules, governed by near chiral field. These modes are therefore very important to detect. Here, we present the photo-acoustic spectroscopy as a low-cost, reliable, sensitive and scattering-free tool to measure the spectral position and absorption efficiency of these modes. The investigated samples are hexagonal nanowires with GaAs core; the fabrication by means of lithography-free molecular beam epitaxy provides controllable and uniform dimensions that allow for the excitation of the fundamental resonant mode around 800 nm. We show that the modulation frequency increase leads to the discrimination of the resonant mode absorption from the overall absorption of the substrate. As the experimental data are in great agreement with numerical simulations, the design can be optimized and followed by photo-acoustic characterization for a specific application

Recurrence to shrinking targets on typical self-affine fractals

We explore the problem of finding the Hausdorff dimension of the set of points that recur to shrinking targets on a self-affine fractal. To be exact, we study the dimension of a certain related symbolic recurrence set. In many cases this set is equivalent to the recurring set on the fractal

Dexamethasone in head and neck cancer patients with microvascular reconstruction : No benefit, more complications

Objectives: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri-and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages. Materials and methods: This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60 mg of dexamethasone was administered to 51 patients over three days peri-and post-operatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded. Results: No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p = 0.012). Conclusions: The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri-and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

A quasi-three-dimensional model for predicting rainfall-runoff processes in a forested catchment in Southern Finland

International audienceRunoff generation in a forested catchment (0.18 km2) was simulated using a quasi-three-dimensional rainfall-runoff model. The model was formulated over a finite grid where water movement was assumed to be dominantly vertical in the unsaturated soil zone and horizontal in the saturated soil. The vertical soil moisture distribution at each grid cell was calculated using a conceptual approximation to the one-dimensional Richards equation. The approximation allowed the use of a simple soil surface boundary condition and an efficient solution to the water table elevation over the finite grid. The approximation was coupled with a two-dimensional ground water model to calculate lateral soil water movement between the grid cells and exfiltration over saturated areas, where runoff was produced by the saturation-excess mechanism. Runoff was an input to a channel network, which was modelled as a nonlinear reservoir. The proposed approximation for the vertical soil moisture distribution in unsaturated soil compared well to a numerical solution of the Richards equation during shallow water table conditions, but was less satisfactory during prolonged dry periods. The simulation of daily catchment outflow was successful with the exception of underprediction of extremely high peak flows. The calculated water table depth compared satisfactorily with the measurements. An overall comparison with the earlier results of tracer studies indicated that the modelled contribution of direct rainfall/snowmelt in streamflow was higher than the isotopically traced fraction of event-water in runoff. The seasonal variation in the modelled runoff-contributing areas was similar to that in the event-water-contributing areas from the tracer analysis

Water and nitrogen processes along a typical water flowpath and streamwater exports from a forested catchment and changes after clear-cutting: a modelling study

International audienceA two dimensional model, FEMMA, to describe water and nitrogen (N) fluxes within and from a forested first-order catchment (Kangasvaara in Eastern Finland) was constructed by linking the most significant processes affecting the fluxes of water, ammonium, nitrate and dissolved organic nitrogen along a hillslope from the water divide to the stream. The hillslope represents the average flowpath of water in the catchment and the model was used to estimate the N fluxes for a catchment in eastern Finland before and after clear-cutting. The simulated results were in reasonable agreement with the nitrate, dissolved organic N and dissolved total N measurements from the study catchment and with other results in the literature. According to the simulations, the major sinks of N after clear-cutting were immobilisation by soil microbes, uptake by ground vegetation and sorption to soil. These sinks increased downslope from the clear-cut area, indicating the importance of an uncut buffer zone between the stream and the clear-cut area in reducing N exports. The buffer zone retained 76% of the N flux coming from the clear-cut area. Nitrification was a key process in controlling the N export after clear-cutting and N increases were mainly as nitrate. Most of the annual N export took place during the spring flood, when uptake of N by plants was minimal