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Introduction Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis. Material and methods This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression ‐ improvement (CGI‐I), 15D‐measure of health‐related quality of life, and Biberoglu and Behrman (B&B) score. Results A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one‐year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2–9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain‐related items. Worst experienced daily pain decreased among those who returned 12‐month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4–12) to 4.5 (0–6), p = 0.002. Conclusions Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients. The treatment of chronic pelvic pain related to endometriosis is difficult and the mainstream remain medical therapy and surgery. Based on the preliminary findings of our study, it appears that SNM is a promising treatment option of CPP in endometriosis patients that do not respond to conventional therapies.

Objective The follow-up of the increasing number of cancer survivors threatens to overload the health care system. While short message system (SMS)–based communication is widely used in other areas of the health care system, there are no studies of its appliance in cancer surveillance. The aim of the current study was to analyze the acceptability, convenience and impact of a novel mobile phone messaging -based system (Mobile-CEA) on health personnel contacts in patients with colorectal cancer (CRC) during 2 years of follow-up. Methods The follow-up data of 52 curatively treated patients with CRC (22 Mobile-CEA-, 30 standard surveillance) was collected retrospectively from the electronic archives. Mobile-CEA patient satisfaction was measured by a tailored non-validated questionnaire. Health personnel satisfaction was assessed by personal interviews. Results Mobile-CEA surveillance group had less health personnel contacts than the standard surveillance group: median 3 (min 0–max 7) vs 5 (min 4–max 7) and 77.2% of the Mobile-CEA group had less than 4 contacts (minimum with the standard surveillance) to health personnel. There were no recurrences in either group. Mobile-CEA patients were satisfied with this novel follow-up method. Health personnel considered it as a practical and safe tool in CRC surveillance. Conclusion Mobile-CEA surveillance seems to be a promising and effective follow-up method for curatively treated patients with CRC. Further studies and experiences are needed.

Excision of all endometriotic lesions is the method of choice in the treatment of severe endometriosis resistant to medical therapy. The infiltrating nature of the disease as well as extensive surgery may, however, cause chronic pain that cannot be relieved by either surgery or hormonal treatment. As a pilot treatment, we tested the effect of sacral neuromodulation (SNM) for four endometriosis patients suffering chronic pelvic pain and pelvic organ dysfunction after radical surgical treatment. Three out of four patients reported improvement in their symptoms during the neuromodulation testing period and a permanent pulse generator was installed. After 2.5 years, all three patients report better quality of life and want to continue with SNM.

ObjectivesThe gold standard of postpartum anal sphincter imaging has been the 3D endoanal ultrasound (EAUS). Development of magnetic resonance imaging (MRI) has allowed anal sphincter evaluation without the use of endoanal coils. The aim of this study is to compare these two modalities in diagnosing residual sphincter lesions post obstetric anal sphincter injury (OASI).MethodsForty women were followed up after primary repair of OASI with both 3D EAUS and external phased array MRI. Details of the anal sphincter injury and sphincter musculature were gathered and analysed.ResultsThere was a moderate interrater reliability (κ = 0.510) between the two imaging modalities in detecting sphincter lesions, with more lesions detected by MRI. There was a moderate intraclass correlation (ICC) between the circumference of the tear (κ = 0.506) and a fair ICC between the external anal sphincter thickness measurements at locations 3 and 9 on the proctologic clock face (κ = 0.320) and (κ = 0.336).ConclusionsThe results of our study indicate that the use of external phased array MRI is feasible for detecting obstetric anal sphincter lesions postpartum. This allows for imaging of the sphincter defects in centres where EAUS imaging is not available.Key Points• A two centre prospective study that showed external phased array MRI to be a valid imaging modality for diagnosing obstetric anal sphincter injuries.

Background and aims : Recent advances in surgical techniques and adjuvant treatments have decreased morbidity and mortality in patients with rectal cancer. The aim of this study was to clarify the effects of aging on the choice, feasibility and safety of various treatment modalities in patients with rectal cancer. Patients and methods : During 2003–2006, a total of 274 rectal cancers were diagnosed at Turku University Central Hospital. Patient and tumor characteristics, treatment modalities chosen, and complications were recorded, and patients were followed up prospectively for 1–3 years after treatment. Patients were then divided into two groups: under 75 (n=181) and 75 years or older (n=93) at the moment of diagnosis. Patient data in the two age groups were analysed and compared with each other. Results : Of the total of 274 patients with rectal cancer, 243 (89%) underwent surgery. The percentage of patients operated was higher (pp=0.03) in the younger (92%) than in the older group (83%). The main reasons for non-operative or palliative treatment were severe concomitant diseases and metasta-sized cancer. Preoperative radiation therapy was given more often (p<0.01) to young (72%) than old (27%) patients. With these selections, there was no difference in 30-day postoperative mortality (1% vs 1%, ns) or postoperative complications (22% vs 34%, ns) between two groups. Conclusion : With preoperative selection, patients over 75 with rectal cancer are suitable for major surgery, as morbidity and mortality rates are comparable to those in younger patients.

The general negative impact of forestry on wood-inhabiting fungal diversity is well recognized, yet the effect of forest naturalness is poorly disentangled among different fungal groups inhabiting dead wood of different tree species. We studied the relationship between forest naturalness, log characteristics and diversity of different fungal morpho-groups inhabiting large decaying logs of similar quality in spruce dominated boreal forests. We sampled all non-lichenized fruitbodies from birch, spruce, pine and aspen in 12 semi-natural forest sites of varying level of naturalness. The overall fungal community composition was mostly determined by host tree species. However, when assessing the relevance of the environmental variables separately for each tree species, the most important variable varied, naturalness being the most important explanatory variable for fungi inhabiting pine and aspen. More strikingly, the overall species richness increased as the forest naturalness increased, both at the site and log levels. At the site scale, the pattern was mostly driven by the discoid and pyrenoid morpho-groups inhabiting pine , whereas at the log scale, it was driven by pileate and resupinate morpho-groups inhabiting spruce. Although our study demonstrates that formerly managed protected forests serve as effective conservation areas for most wood-inhabiting fungal groups, it also shows that conservation planning and management should account for group- or host tree -specific responses.

A nanograined YBCO target, where a great number of grain boundaries, pores etc. exist, is shown to hold an alternative approach to future pulsed laser deposition based high-temperature superconductor thin film and coated conductor technologies. Although the nanograined material is introduced earlier, in this work, we comprehensively demonstrate the modified ablation process, together with unconventional nucleation and growth mechanisms that produces dramatically enhanced flux pinning properties. The results can be generalized to other complex magnetic oxides, where an increased number of defects are needed for modifying their magnetic and electrical properties, thus improving their usability in the future technological challenges.

This article describes how Public Safety Organisations (PSO) come up against hybrid, demanding operations like terrorist attack or school shootings more frequently. Obtaining a realistic situation picture is crucial in organising the rescue operation and in minimising further violence. The role of PSOs' 24/7 situation centres becomes vital. In this paper, the authors explore how PSOs can ensure an information flow and a situation picture in hybrid environments. The empirical data were official reports and the data collected through interviews with staff at different PSOs. It was analysed using qualitative content analysis. Achieving a common operational picture involves taking account of each authority's needs and constraints, thereby enabling the exchange of relevant information between key authorities on-scene and off-scene. In addition, human factors play an important role in complex, multi-authority missions. Furthermore, the increasing role of citizens and social media in producing valuable information should not be overlooked.

School shootings are demanding operations for the police, emergency medical services, rescue services, and the Emergency Response Centre. Obtaining a realistic situation picture while the operation is still ongoing, and the perpetrator has yet to be apprehended, is crucial in organising the rescue operation and in minimising further violence. During a shooting incident, the amount of information from different sources can be excessive and there are instances of information overload. The students and staff inside the school and the Emergency Response Centre have valuable information about what is happening inside the building. Police make observations continuously, while searching for the perpetrator(s) and rescuing people. Paramedics and rescue services receive information as to what has happened from those already rescued. It is by no means a straightforward process to collect and collate all the cues and crucial information obtained from the different authorities during the mission, so as to form a common operational picture and to support the development of team situational awareness. However, adequate information management is regarded as a critical success factor in overcoming the challenges of information-sharing during multi-authority missions. Achieving a common operational picture involves taking account of each authority's needs and constraints, thereby enabling the exchange of relevant information between key authorities on-scene and off-scene. According to the literature, sense-making issues between actors with different institutional backgrounds lead to inter-organisational coordination problems. To date, there have been two school shootings in Finland, with a total of 20 fatalities. The incidents occurred in a high school and a polytechnic institution respectively. In this paper, we develop a case study based on official reports and interviews vis-à-vis the two shootings. First, we aim to describe the main elements of information flow during the two incidents in Finland. Next, we analyse the challenges entailed in forming the situation picture on-scene and off-scene in a hybrid environment. Lastly, we discuss the actions implemented to improve information-sharing and the development of the co-operation between the police, the emergency medical services, the rescue services, and the Emergency Response Centre. The latest technology now in use and the role of social media will also be discussed.