Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices

Objectives: Outcomes of pediatric-onset portal hypertension are poorly defined. We aimed to assess population-based long-term outcomes of pediatric-onset portal hypertension complicated by varices. Methods: All children with esophageal varices (n = 126) were identified from 14,144 single nationwide referral center endoscopy reports during 1987 to 2013, and followed up through national health care and death registers. A questionnaire was sent to survivors (n = 94) of whom 65 (69%) responded. Results: Nineteen underlying disorders included biliary atresia (35%), extrahepatic portal vein obstruction (35%), autosomal recessive polycystic kidney disease (7%), and other disorders (23%). During median follow-up of 15.2 (range 0.5-43.1) years patients underwent median 9 (1-74) upper gastrointestinal endoscopies. Esophageal varices were first observed at a median age of 4.0 (0.3-18.2) years, 112 (89%) patients underwent median 6 (1-56) sclerotherapy/banding sessions, and 61 (48%) experienced median 2 (range 1-20) variceal bleeding episodes. Forty-eight surgical shunt procedures were performed to 41 (36%) patients and 38% underwent liver transplantation. Portal hypertensive biliopathy was diagnosed in 4 patients. Hepatopulmonary syndrome necessitated liver transplantation in 2 patients, hepatic encephalopathy in 2, and hepatorenal syndrome in 1. No patient died of variceal bleeding. Patient-reported perception of health on a scale of 1 to 10 was 9 (range 4-10), and 86% reported no current symptoms attributable to esophageal varices. Conclusions: Pediatric-onset portal hypertension is a heterogeneous disease with significant long-term morbidity, requiring multimodal approach with considerable resources and continuation of follow-up in adulthood. Although mortality to variceal bleeding was avoided, bleeding episodes recurred also in adulthood, while patient-reported health of long-term survivors was encouraging.Peer reviewe

Tibial Fractures in Alpine Skiing and Snowboarding in Finland : A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients

Background and Aim: Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. Materials and methods: All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. Results: There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n=215, 63%), followed by proximal tibial fractures (n=92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p Conclusion: The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults.Peer reviewe

Epithermal Neutron Beam Interference with Cardiac Pacemakers

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

Atomic dynamics in evaporative cooling of trapped alkali atoms in strong magnetic fields

We investigate how the nonlinearity of the Zeeman shift for strong magnetic fields affects the dynamics of rf field induced evaporative cooling in magnetic traps. We demonstrate for the 87-Rb and 23-Na F=2 trapping states with wave packet simulations how the cooling stops when the rf field frequency goes below a certain limit (for the 85-Rb F=2 trapping state the problem does not appear). We examine the applicability of semiclassical models for the strong field case as an extension of our previous work [Phys. Rev. A 58, 3983 (1998)]. Our results verify many of the aspects observed in a recent $^{87}$Rb experiment [Phys. Rev. A 60, R1759 (1999)].Comment: 9 pages, RevTex, eps figures embedde

Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy

Study of bound states in 12Be through low-energy 11Be(d,p)-transfer reactions

The bound states of 12Be have been studied through a 11Be(d,p)12Be transfer reaction experiment in inverse kinematics. A 2.8 MeV/u beam of 11Be was produced using the REX-ISOLDE facility at CERN. The outgoing protons were detected with the T-REX silicon detector array. The MINIBALL germanium array was used to detect gamma rays from the excited states in 12Be. The gamma-ray detection enabled a clear identification of the four known bound states in 12Be, and each of the states has been studied individually. Differential cross sections over a large angular range have been extracted. Spectroscopic factors for each of the states have been determined from DWBA calculations and have been compared to previous experimental and theoretical results