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

Nanoscale density fluctuations in swift heavy ion irradiated amorphous SiO2

We report on the observation of nanoscale density fluctuations in 2 μm thick amorphous SiO₂ layers irradiated with 185 MeV Au ions. At high fluences, in excess of approximately 5 × 10¹² ions/cm², where the surface is completely covered by ion tracks, synchrotron small angle x-ray scattering measurements reveal the existence of a steady state of density fluctuations. In agreement with molecular dynamics simulations, this steady state is consistent with an ion track “annihilation” process, where high-density regions generated in the periphery of new tracks fill in low-density regions located at the center of existing tracks.The authors acknowledge the Australian Research Council and the Australian Synchrotron Research Program for financial support and thank the staff at the ANU Heavy Ion facility for their continued technical assistance. O.P., F.D., and K.N. acknowledge financial support from the Academy of Finland under its Centre of Excellence program as well as the OPNA project, and grants of computer capacity from CSC

First-principles study of adsorption, diffusion, and charge stability of metal adatoms on alkali halide surfaces

In this work we have performed first-principles calculations based on the spin-polarized density-functional theory for the adsorption and diffusion of Au, Ag, and Pb atoms on NaCl(001), KCl(001), and KBr(001) surfaces. We consider also the influence of adatom charge on the adsorption and diffusion. In order to characterize the different systems we explicitly calculate charge transfer between surface and adatom and consider the relative stability of the various charge states. Our results show that in general, apart from positively charged systems, the adatoms are weakly bound to the surface via orbital polarization and ionic interactions, and relatively little charge transfer occurs. Au and Ag adatoms are highly mobile on all surfaces, although they can be pinned by removal of an electron. In contrast, Pb adatoms are fairly immobile, and their mobility increases upon charging. Analysis of the charge stability suggests that Ag offers the potential of charge controlled mobility on insulators.Peer reviewe

Epithermal Neutron Beam Interference with Cardiac Pacemakers

Peer reviewe

Longitudinal evolution of catheter-related bloodstream infections, kidney function and liver status in a nationwide adult intestinal failure cohort

Objectives The development of intestinal failure-related complications in Finnish adults is unknown. This study aimed to investigate the incidence of catheter-related bloodstream infections (CRBSI), and the longitudinal changes in biochemical liver and kidney tests in a nationwide cohort. Materials and methods The search for Finnish adults with intestinal failure (IF) utilized a survey to Finnish health-care providers (n = 111) with the potential to provide long-term parenteral support (PS) for adult IF. Our nationwide, cross-sectional cohort included all IF patients aged >= 18 years who had received PS for >= 120 d in 2017. Data regarding CRBSI and biochemical liver and kidney tests were collected from patient records at the start of PS up to the latest available measurement in 2017. Results In the nationwide cohort of 52 patients, the CRBSI incidence was 1.35/1000 catheter days. Seventy-three percent of CRBSI in a long-term catheter led to catheter replacement. During a median PS duration of 27.5 (interquartile range [IQR] 11.3-57.3) months, a statistically significant median change occurred in estimated glomerular filtration rate (eGFR; -8.5 ml/min/1.73 m(2), IQR -30-7, p = .005) and alkaline phosphatase (ALP; 26 U/l, IQR -11-95, p = .019). In a multiple regression model for eGFR at data collection, baseline eGFR and age were strong explanatory variables. Conclusions Incidence of CRBSI, but not treatment strategies, in this nationwide adult IF population correspond well to those reported from specialized centers. Decreased kidney function and abnormal liver test results are frequent findings, and even more so over time, emphasizing the importance of regular monitoring.Peer reviewe

Simulating atomic force microscopy imaging of the ideal and defected TiO2 (110) surface

In this study we simulate noncontact atomic force microscopy imaging of the TiO2 (110) surface using first-principles and atomistic methods. We use three different tip models to investigate the tip-surface interaction on the ideal surface, and find that agreement with experiment is found for either a silicon tip or a tip with a net positive electrostatic potential from the apex. Both predict bright contrast over the bridging oxygen rows. We then study the interaction of this tip with a bridging oxygen vacancy on the surface, and find that the much weaker interaction observed would result in vacancies appearing as dark contrast along the bright rows in images.Peer reviewe

Transumbilical versus lateral transabdominal removal of benign adnexal masses in laparoscopic surgery-A randomized trial

Objective: In laparoscopic adnexal surgery the conventional method of removing a mass from the abdominal cavity in Finland is through a 10-mm-wide lateral abdominal port. The larger the lateral trocar, the greater the risk of pain, complications and delayed recovery. Here, we assumed that adnexal mass removal through a 10-mm umbilical port together with 5-mm side trocars would decrease the postoperative need of analgesics when compared with removal through a 10-mm lateral abdominal port. Study design: Women scheduled for laparoscopic surgery of a benign adnexal mass were invited to participate. The participants were randomized into two groups: removal via the transumbilical (TO) (n = 21) or lateral transabdominal (TA) (n= 21) route. General anesthesia and use of local anesthetics were standardized. The amount of postoperative opioid (oxycodone) and visual analog scale (VAS) scores for pain were the primary outcome measures. Secondary outcome measures were nausea/vomiting (VAS evaluation), time to discharge, peri- and postoperative complications, surgeons' opinions of the alternative methods and patients' satisfaction, evaluated via a questionnaire sent six months postoperatively. Results: There were no significant differences in the use of opioids or median pain-VAS scores between the groups during the first 24 h postoperatively. However, in the TU group the amount of women with very low pain-VAS scores (0-1) during the whole 12-h follow-up time was significantly greater than in the TA group (4 vs. 0 women p=0.04). The amounts of nausea and vomiting, and median times to discharge were similar in both groups. There were no major complications. Conclusions: Both transumbilical and transabdominal routes of abdominal mass removal during laparoscopy were feasible and safe. However, the transumbilical route resulted in more women with very low pain-VAS scores. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

High-resolution scanning force microscopy of gold nanoclusters on the KBr (001) surface

In this study we use a combination of dynamic scanning force microscopy experiments and first-principles simulations to study the imaging process of gold nanoclusters adsorbed on the (001) surface of KBr. In previous experiments atomic resolution was readily obtained on the KBr substrate. However, it was not possible to resolve atoms within the clusters themselves. This correlates with imaging simulations we present here using several different probable tip models: measurable contrast was readily achieved on the KBr surface and on the gold (001) surface, but simulations on the clusters demonstrated poor contrast for all tips. We further consider the role of cluster charging in the tip-surface interaction, and the role that surface defects play in the properties of adsorbed clusters.Peer reviewe

Trade-offs among spatio-temporal management actions for a mixed-stock fishery revealed by Bayesian decision analysis

Management and conservation of populations that are harvested simultaneously present a unique set of challenges. Failure to account for differences in productivity and spatio-temporal abundance patterns can lead to over-exploitation of depleted populations and/or loss of potential yield from healthy ones. Mixed-stock fisheries (where a stock may comprise one or more populations of reared or wild origin) harvest multiple stocks, often in unknown proportions, and lack of tools for estimation of stock-specific harvest rates can hamper status evaluations and attainment of management goals. We present a method for evaluating stock-specific impacts of alternative harvest strategies, using coastal trap net fisheries for Atlantic salmon (Salmo salar) in the Baltic Sea as a case study. Our results demonstrate a large variation among stocks in coastal mixed fishery harvest rates, as well as large differences in harvest rates relative to stock-specific maximum sustainable yield (MSY) and recovery levels. Bayesian decision analysis showed that spatio-temporal management actions, such as delayed fishery opening and closed areas may be effective in improving probabilities of meeting management objectives for Baltic salmon. However, stocks did not respond uniformly to different management actions, highlighting the potential for trade-offs in reaching stock-specific targets that must be considered by managers

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