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

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

Epithermal Neutron Beam Interference with Cardiac Pacemakers

Peer reviewe

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

Effect of web rheology and peeling on web transfer in open draw

To achieve higher productivity in papermaking, the increasing of web speed is the most efficient way. However, velocity increase will also immediately cause greater demands according to the web strength.In normal papermaking process, the form of the web changes gradually through the forming and press sections from suspension to solid form. After the press section, the basic fiber structure of the paper has already been created, but its rheological properties are in the beginning state of their development. Due to the water removal method by pressing the wet fiber network against a press roll surface, an adhesion force is generated between the web and the surface.At the end of the press section, the strength of the web is still very low due to the web's great moisture content. At this point, the mechanical properties of the paper can be affected or even deteriorated by wrong web peeling methods. For this reason, the understanding and controlling of the adhesional behaviour of the web is essential especially in the cases of high velocity levels.This paper studies the adhesional behaviour of the open draw, which is usually the first time during the papermaking process when the wet web is stressed mechanically in the longitudinal direction. This behaviour is studied by a quasi-dynamic mathematical model, which includes force balance and continuity models and also a rheological model for the open draw and material properties of the web respectively.The model consists of steady-state and nonsteady-state portions. Time-dependency is applied through mass flow and rheological equations, force balance equation is in static form. The solving method for this coupled equation system is to first solve the ideal steady-state situation and, after this nonsteady-stale equations which can be solved by using the steady-state situation as an initial condition.The qualitative behaviour of this model is correct, for example the increase in peeling angle between the surface and the web can be observed in cases of both velocity increase and adhesion energy increase even if the relative speed difference of the open draw has remained constant. Limitations appear mainly in the correctness of web material, adhesion and external pressure parameters. However, by using this model, also the effects of such external disturbances as adhesion and pressure disturbances can be studied efficiently.One of the main results is also an exponential increase in the peeling angle as a function of velocity. In this paper, it is caused by the centripetal force affecting the web.As a conclusion, the peeling behaviour of the wet web in an open draw is a very sensitive system. The main advantage of this system is its capability to self-adjustment through changes of the mass flow rate and peeling angle. However, also the rheological properties of the web and the adhesion force itself play a significant role in the optimization and stabilization of the web transfer in an open draw

Role of van der Waals forces in the adsorption and diffusion of organic molecules on an insulating surface

The adsorption and diffusion of 3,4,9,10-perylene-tetracarboxylic-dianhydride (PTCDA) molecules on a nanostructured KBr (001) surface were investigated by combining noncontact atomic force microscopy (NC-AFM) and first-principles calculations. Atomically resolved measurements demonstrate trapping of PTCDA molecules in intentionally created rectangular monolayer-deep substrate pits and a preferential adsorption at kink sites. In order to understand the experimental results, we found that it was essential to include a first-principles treatment of the van der Waals interactions. We show that at some sites on the surface, 85% of the molecular binding is provided by van der Waals interactions, and in general it is always the dominant contribution to the adsorption energy. It also qualitatively changes molecular diffusion on the surface. Based on the specificity of the molecular interaction at kink sites, the species of the imaged ionic sublattice in the NC-AFM measurements could be identified.Peer reviewe

A comparative cohort study of Duhamel and Endorectal Pullthrough for Hirschsprung's Disease

Background: There are limited data available to compare outcomes between surgical approaches for Hirschsprung’s disease. Duhamel and endorectal pull-through (ERPT) are two of the most common procedures performed worldwide. // Methods: Objective outcomes were compared between contemporary cohorts (aged 4–32 years) after Duhamel or ERPT using case–control methodology. Data were collected using prospectively administered standardized questionnaires on bowel and bladder function and quality of life (Pediatric Quality of Life Inventory, Short form 36 and Gastrointestinal Quality of Life Index). Patients were compared in two age groups (18 years and younger and older than 18 years) and reference made to normative control data. Multivariable analysis explored factors associated with poor outcomes. // Results: Cohorts were well matched by demographics, disease characteristics and incidence of postoperative complications (120 patients who underwent Duhamel versus 57 patients who had ERPT). Bowel function scores were similar between groups. Patients who underwent Duhamel demonstrated worse constipation and inferior faecal awareness scores (P < 0.01 for both age groups). Recurrent postoperative enterocolitis was significantly more common after ERPT (34 versus 6 per cent; odds ratio 15.56 (95 per cent c.i. 6.19 to 39.24; P < 0.0001)). On multivariable analysis, poor bowel outcome was the only factor significantly associated with poor urinary outcome (adjusted odds ratio 6.66 (95 per cent c.i. 1.74 to 25.50; P = 0.006)) and was significantly associated with markedly reduced quality of life (QoL) in all instruments used (P < 0.001 for all). There were no associations between QoL measures and pull-through technique. // Conclusion: Outcomes from Duhamel and ERPT are good in the majority of cases, with comparable bowel function scores. Constipation and impaired faecal awareness were more prevalent after Duhamel, with differences sustained in adulthood. Recurrent enterocolitis was significantly more prevalent after ERPT. Clustering of poor QoL and poor functional outcomes were observed in both cohorts, with seemingly little effect by choice of surgical procedure in terms of QoL

Shape coexistence at the proton drip-line: First identification of excited states in 180Pb

Excited states in the extremely neutron-deficient nucleus, 180Pb, have been identified for the first time using the JUROGAM II array in conjunction with the RITU recoil separator at the Accelerator Laboratory of the University of Jyvaskyla. This study lies at the limit of what is presently achievable with in-beam spectroscopy, with an estimated cross-section of only 10 nb for the 92Mo(90Zr,2n)180Pb reaction. A continuation of the trend observed in 182Pb and 184Pb is seen, where the prolate minimum continues to rise beyond the N=104 mid-shell with respect to the spherical ground state. Beyond mean-field calculations are in reasonable correspondence with the trends deduced from experiment.Comment: 5 pages, 4 figures, submitted to Phys.Rev.

Renal function after combined liver-kidney transplantation : A longitudinal study of pediatric and adult patients

It has been proposed that the liver protects the kidney in CLKT. However, few studies have examined long-term renal function after CLKT and contrasted renal function of CLKT patients to KT patients beyond one year after transplantation. We studied long-term renal function of CLKT patients and compared renal function of CLKT patients to KT patients between one and five years after transplantation. Patients who underwent CLKT between 1993 and 2011 were included (n = 34; 11 children and 23 adults). Ninety-six (27 children and 69 adults) KT patients were selected as controls. GFR was estimated (eGFR) and measured (mGFR) with Cr-51-EDTA clearance. Mean mGFR was 63 at one and 70 at ten years after pediatric CLKT. Mean eGFR was 75 at one and 50 at ten years after adult CLKT. Difference in mean mGFR between pediatric CLKT and KT patients was 8 (95% CI -7 to 23) and 11 (95% CI -4 to 26) at one and five years after transplantation, respectively. Difference in mean eGFR between adult CLKT and KT patients was 8 (95% CI -5 to 20) and 1 (95% CI -10 to 12) at one and five years after transplantation, respectively. Longitudinal changes in GFRs were somewhat similar in CLKT and KT patients in both age-groups but pediatric CLKT patients had on average higher GFRs than pediatric KT patients. In long-term follow-up, renal function remains stable in pediatric CLKT patients but declines in adult CLKT patients.Peer reviewe