Redo ventral rectopexy : is it worthwhile?

Background Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). Methods This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. Results A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. Conclusions Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.Peer reviewe

HIF-P4H-2 inhibition enhances intestinal fructose metabolism and induces thermogenesis protecting against NAFLD

Non-alcoholic fatty liver disease (NAFLD) parallels the global obesity epidemic with unmet therapeutic needs. We investigated whether inhibition of hypoxia-inducible factor prolyl 4-hydroxylase-2 (HIF-P4H-2), a key cellular oxygen sensor whose inhibition stabilizes HIF, would protect from NAFLD by subjecting HIF-P4H-2-deficient (Hif-p4h-2(gt/gt)) mice to a high-fat, high-fructose (HFHF) or high-fat, methionine-choline-deficient (HF-MCD) diet. On both diets, the Hif-p4h-2(gt/gt) mice gained less weight and had less white adipose tissue (WAT) and its inflammation, lower serum cholesterol levels, and lighter livers with less steatosis and lower serum ALT levels than the wild type (WT). The intake of fructose in majority of the Hif-p4h-2(gt/gt) tissues, including the liver, was 15-35% less than in the WT. We found upregulation of the key fructose transporter and metabolizing enzyme mRNAs, Slc2a2, Khka, and Khkc, and higher ketohexokinase activity in the Hif-p4h-2(gt/gt) small intestine relative to the WT, suggesting enhanced metabolism of fructose in the former. On the HF-MCD diet, the Hif-p4h-2(gt/gt) mice showed more browning of the WAT and increased thermogenesis. A pharmacological pan-HIF-P4H inhibitor protected WT mice on both diets against obesity, metabolic dysfunction, and liver damage. These data suggest that HIF-P4H-2 inhibition could be studied as a novel, comprehensive treatment strategy for NAFLD. Key messages center dot HIF-P4H-2 inhibition enhances intestinal fructose metabolism protecting the liver. center dot HIF-P4H-2 inhibition downregulates hepatic lipogenesis. center dot Induced browning of WAT and increased thermogenesis can also mediate protection. center dot HIF-P4H-2 inhibition offers a novel, comprehensive treatment strategy for NAFLD.Peer reviewe

Development of otology specific outcome measure : Ear Outcome Survey-16 (EOS-16)

Purpose: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. Methods: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. Results: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. Conclusions: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument. (C) 2021 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.Peer reviewe

Kantatien 63 parantaminen välillä Ina–Kaustinen : Pääsuuntaselvitys

Kantatie 63 Kauhava–Ylivieska (169 km) on tärkeä maakuntien välinen päätie, joka toimii yhteytenä kuntakeskusten, seutujen ja maakuntien välillä, mm. tärkeänä elinkeinoelämän kuljetusten reittinä. Kantatie 63 on Väyläviraston Pääteiden palvelutaso ja tulevaisuuden tarpeet -selvityksen mukainen muu päätie. Kantatie 63 on parannettu vastaamaan päätieverkon palvelutasovaatimuksia lukuun ottamatta moniongelmaista tieosuutta välillä Ina–Kaustinen. Kantatie 63 Inan ja Kaustisen välillä (14 km) on kapea, mutkainen ja mäkinen päätie, joka kulkee useiden kylien läpi. Keskimääräinen vuorokausiliikennemäärä vaihtelee välillä 1 700–2 300 ajoneuvoa vuorokaudessa (KVL 2019), josta raskaan liikenteen osuus on huomattava 12–15 %. Tien nopeusrajoitus on pääosin 70 km/h, mutta kyläkeskusten kohdilla nopeusrajoitus on 60 km/h. Pääsuuntaselvityksen tavoitteena oli määrittää väyläratkaisut, joilla kantatielle määritetty ennustetilanteen tavoitetaso saavutetaan. Ensisijaisena ja valtakunnallisena liikenteellisenä tavoitteena on parantaa pitkämatkaisen tavara- ja henkilöliikenteen sujuvuutta, ennustettavuutta ja matka-aikaa. Lisäksi tavoitteita on asetettu jalankulun ja pyöräilyn olojen ja liikenneturvallisuuden parantamiseksi sekä liikenteen ympäristövaikutusten vähentämiseksi. Työn aikana tutkittiin useita eri linjausvaihtoehtoja, joista hankeryhmän keskustelun pohjalta Väyläviraston ohjeistuksen mukaiseen hankearviointiin valittiin neljä linjausluonnosta. Hankearvioinnin perusteella lähempään tarkasteluun valittiin kaksi vaikuttavuudeltaan parasta ja realistisinta vaihtoehtoa, jotka esiteltiin yleisötilaisuudessa syyskuussa 2021. Hankeryhmä päätti yksimielisesti esittää jatkosuunnitteluun hyötykustannussuhteeltaan, vaikuttavuudeltaan ja toteutustodennäköisyydeltään parempaa läntistä vaihtoehtoa, jossa kantatie 63 parannetaan uuteen maastokäytävään noin 9 km matkalta ja muulta jaksolta levennetään. Valitun vaihtoehdon mukaisessa tavoitetilanteessa kantatien poikkileikkaus 9,0/7,0 m ja nopeusrajoitus pääosin 100 km/h

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.Peer reviewe

Förbättring av stamväg 63 mellan Ena i Evijärvi och Kaustby : Lokaliseringsplan

Stamväg 63 Kauhava–Ylivieska (169 km) är en viktig huvudväg mellan landskap som fungerar som förbindelse mellan kommuncentrum, regioner och landskap samt utgör en viktig rutt för bl.a. näringslivets transporter. I enlighet med Trafikledsverkets utredning angående servicenivån på huvudvägar och framtida behov hör stamväg 63 till kategorin annan huvudväg. Utom det multiproblematiska avsnittet mellan Ena–Kaustby har stamväg 63 förbättrats så att den motsvarar de krav på servicenivån som ställs på huvudvägsnätet. Stamväg 63 mellan Ena och Kaustby (14 km) är en smal, krokig och backig huvudväg som går genom flera byar. Den genomsnittliga dygnstrafiken varierar mellan 1 700–2 300 fordon per dygn (KVL 2019), varav andelen tung trafik är betydande, 12–15 %. Hastighetsbegränsningen på vägen är huvudsakligen 70 km/h, men vid bycentrumen 60 km/h. Målet med lokaliseringsutredningen var att definiera trafikledslösningar genom vilka den för stamvägen ställda målnivån enligt prognosen uppnås. Det primära och riksomfattande trafikmässiga målet är att förbättra den långresa gods- och persontrafikens smidighet, förutsägbarhet och restid. Det har ställts ytterligare mål för att förbättra gång- och cykelförhållanden och trafiksäkerhet samt för att minska trafikens miljökonsekvenser. Under arbetets gång granskades flera olika sträckningsalternativ, varav på basis av projektgruppens diskussion valdes fyra utkast till sträckning för en projektbedömning som utfördes enligt Trafikledsverkets riktlinjer. På basis av projektbedömningen valdes sedan för närmare granskning två alternativ som med avsikt på genomslagskraft var de bästa och mest realistiska. De presenterades vid ett möte för allmänheten i september 2021. Projektgruppen beslöt enhälligt att föreslå det västra alternativet för den fortsatta planeringen, eftersom det på basis av projektbedömningen är bättre med avsikt på nyttokostnadsförhållande, genomslagskraft och sannolikhet för förverkligande. I detta alternativ förbättras stamväg 63 i en ny terrängkorridor på en sträcka av cirka 9 km och breddas för de övriga sträckorna. I måltillståndet av det valda alternativet är stamvägens tvärsektion 9,0/7,0 m och hastighetsbegränsningen huvudsakligen 100 km/h

Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16)

PurposeAn important outcome measure of patient care is the impact on the patient’s health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases.MethodsA preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients’ responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis.ResultsThe relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months.ConclusionsEOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.</p

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design:Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.</p