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

Mass spectrometry strategies to unveil modified aminophospholipids of biological interest

The biological functions of modified aminophospholipids (APL) have become a topic of interest during the last two decades, and distinct roles have been found for these biomolecules in both physiological and pathological contexts. Modifications of APL include oxidation, glycation, and adduction to electrophilic aldehydes, altogether contributing to a high structural variability of modified APL. An outstanding technique used in this challenging field is mass spectrometry (MS). MS has been widely used to unveil modified APL of biological interest, mainly when associated with soft ionization methods (electrospray and matrix-assisted laser desorption ionization) and coupled with separation techniques as liquid chromatography. This review summarizes the biological roles and the chemical mechanisms underlying APL modifications, and comprehensively reviews the current MS-based knowledge that has been gathered until now for their analysis. The interpretation of the MS data obtained by in vitro-identification studies is explained in detail. The perspective of an analytical detection of modified APL in clinical samples is explored, highlighting the fundamental role of MS in unveiling APL modifications and their relevance in pathophysiology.publishe

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

Globalization, Global Governance and the Social Determinants of Health: A review of the linkages and agenda for action

The Globalization Knowledge Network (GKN) was formed in 2005 with the purpose of examining how contemporary globalization was influencing social determinants of health. It was one of nine Knowledge Networks providing evidence-informed guidance to the work of the World Health Organization’s Commission on Social Determinants of Health (2005-2008): like most of the Knowledge Networks, its operations were financed by an external funder (in this case, the International Affairs Directorate of Health Canada, Canada’s national ministry of health). The GKN conducted two face-to-face meetings to debate, discuss, outline and review its work, and produced thirteen background papers and a Final Report. These papers and the Final Report underwent extensive internal and external peer review to ensure that their findings and policy inferences accurately reflected available evidence and scholarship. This GKN publication series was prepared under the general editorship of Ronald Labonté, with assistance from Vivien Runnels and copy-editing provided by Wayne Harding. All views expressed are exclusively those of the authors. A complete list of titles in the publication series appears on the inside back cover of this monograph

Modeling and assessment of hydrological changes in a developing urban catchment

Urbanization strongly changes natural catchment by increasing impervious coverage and by creating a need for efficient drainage systems. Such land cover changes lead to more rapid hydrological response to storms and change distribution of peak and low flows. This study aims to explore and assess how gradual hydrological changes occur during urban development from rural area to a medium-density residential catchment. The Stormwater Management Model (SWMM) is utilized to simulate a series of scenarios in a same developing urban catchment. Sub-hourly hydro-meteorological data in warm season is used to calibrate and validate the model in the fully developed catchment in 2006. The validated model is then applied to other cases in development stage and runoff management scenarios. Based on the simulations and observations, three key problems are solved: (1) how catchment hydrology changes with land cover change; (2) how urban development changes pre-development flows; (3) how stormwater management techniques affect catchment hydrology. The results show that the low-frequency flow rates had remarkably increased from 2004 to 2006 along with the increase of impervious areas. Urbanization in the residential catchment expands the runoff contributing area, accelerates hydrological response, raises peak flows in an order of magnitude of over 10, and more than doubles the total runoff volume. The effects of several LID controls on runoff hydrograph were simulated, and the techniques were able to reduce flows towards the pre-development levels. However, the partly restored flow regime was still clearly changed in comparison to the pre-development flow conditions

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

Macronutrient intake during pregnancy in women with a history of obesity or gestational diabetes and offspring adiposity at 5 years of age

Background/objectives The impact of maternal macronutrient intake during pregnancy on offspring childhood adiposity is unclear. We assessed the associations between maternal macronutrient intake during and after pregnancy with offspring adiposity at 5 years of age. Additionally, we investigated whether gestational diabetes (GDM), BMI, or breastfeeding modified these associations. Subjects/methods Altogether, 301 mother-child dyads with maternal prepregnancy BMI >= 30 and/or previous GDM participated in the Finnish Gestational Diabetes Prevention Study (RADIEL) and its 5 years follow-up. Macronutrient intakes (E%) were calculated from 3-day food records collected at 5-18 weeks' gestation, in the third trimester, and at 12 months and 5 years after pregnancy. Offspring body fat mass (BFM) and fat percentage (BF%) at 5 years were measured by bioimpedance. Statistical analyses were multivariate linear regression. Results Mean (SD) prepregnancy BMI was 33(4) kg/m(2). GDM was diagnosed in 47%. In normoglycemic women, higher first half of pregnancy n-3 PUFA intake was associated with lower offspring BFM (g) (ss -0.90; 95% CI -1.62, -0.18) and BF% (ss -3.45; 95% CI -6.17, -0.72). In women with GDM, higher first half of pregnancy n-3 PUFA intake was associated with higher offspring BFM (ss 0.94; 95% CI 0.14, 1.75) and BF% (ss 3.21; 95% CI 0.43, 5.99). Higher SFA intake in the third trimester and cumulative intake across pregnancy (mean of the first half and late pregnancy) was associated with higher BFM and BF% (across pregnancy: ss 0.12; 95% CI 0.03, 0.20 and ss 0.44; 95% CI 0.15, 0.73, respectively). Higher carbohydrate intake across pregnancy was associated with lower BFM (ss -0.044; 95% CI -0.086, -0.003), and borderline associated with BF% (ss -0.15; 95% CI -0.31, 0.00). Conclusions The macronutrient composition of maternal diet during pregnancy is associated with offspring BFM and BF% at 5 years. GDM modifies the association between prenatal n-3 PUFA intake and offspring anthropometrics.Peer reviewe

No effect of gestational diabetes or pre-gestational obesity on 6-year offspring left ventricular function-RADIEL study follow-up

Aims We aimed to investigate associations between pre-pregnancy obesity, gestational diabetes (GDM), offspring body composition, and left ventricular diastolic and systolic function in early childhood. Methods This is an observational study, including 201 mother-child pairs originating from the Finnish Gestational Diabetes Prevention Study (RADIEL; 96 with GDM, 128 with pre-pregnancy obesity) with follow-up from gestation to 6-year postpartum. Follow-up included dyads anthropometrics, body composition, blood pressure, and child left ventricular function with comprehensive echocardiography (conventional and strain imaging). Results Offspring left ventricular diastolic and systolic function was not associated with gestational glucose concentrations, GDM, or pregravida obesity. Child body fat percentage correlated with maternal pre-pregnancy BMI in the setting of maternal obesity (r = 0.23,P = 0.009). After adjusting for child lean body mass, age, sex, systolic BP, resting HR, maternal lean body mass, pre-gestational BMI, and GDM status, child left atrial volume increased by 0.3 ml (95% CI 0.1, 0.5) for each 1% increase in child body fat percentage. Conclusions No evidence of foetal cardiac programming related to GDM or maternal pre-pregnancy obesity was observed in early childhood. Maternal pre-pregnancy obesity is associated with early weight gain. Child adiposity in early childhood is independently associated with increased left atrial volume, but its implications for long-term left ventricle diastolic function and cardiovascular health remain unknown.Peer reviewe