Treatment of metastatic TFE3 microphthalmia transcription factor translocation renal cell carcinoma: a case report.

Background: Microphthalmia-associated transcription factor/transcription factor E (MiTF/TFE) translocation renal cell carcinoma (RCC) is a rare type of non-clear cell RCC (nccRCC), which is more common in females. Currently, there is no standardized treatment for advanced metastatic microphthalmia translocation RCC (MiT-RCC). The main treatment modalities include surgery, chemotherapy, immunotherapy, anti-vascular endothelial growth factor or vascular endothelial growth factor receptor (VEGFR) inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and targeted therapy against the mesenchymal-epithelial transition (MET) factor signaling pathway. Case Description: We present the case of an 8-year-old male patient with hematuria and paroxysmal urinary pain. Based on tumor genetic testing results and targeted drug matching analysis, the patient underwent tumor biopsy, tumor radical surgery with vascular osteotomy, and cervicothoracic lymph node dissection. The patient was then treated with a combination of immunotherapy [sintilimab, a drug directed against programmed cell death receptor-1 (PD-1)] and VEGFR tyrosine kinase inhibitor (TKI) (from pazopanib to sunitinib). Throughout the 10 cycles of conventional chemotherapy (seven courses of sintilimab since the start of the third chemotherapy treatment), the patient's condition remained stable, with no tumor recurrence at the primary site. However, in the later stages, the patient developed a large amount of ascites, and the family requested discontinuation of treatment, ultimately leading to the patient's death. Conclusions: In this case report, we summarize the therapeutic strategy of a young patient with metastatic transcription factor E3 (TFE3) MiT-RCC. For this disease, early immunotherapy and the use of precision-targeted drugs may have a favorable impact on the survival prognosis of the patient but may still be of less benefit in children with advanced multiple metastases. Therefore, further research on tumor driver genes, among other treatment components, is urgently needed to improve precision therapy.

Tetrandrine slows the radiographic progression of progressive massive fibrosis in pneumoconiosis: a retrospective cohort study.

OBJECTIVE: This study aims to explore the clinical effect of Tetrandrine (Tet) on progressive massive fibrosis (PMF) of pneumoconiosis. METHODS: This retrospective study collected 344 pneumoconiosis patients with PMF, and 127 were eligible for the final analysis, including 57 patients in the Tet group and 70 patients in the control group. The progress of imaging and lung function were compared between the two groups. RESULTS: After 13 months (median) of treatment, the size of PMF was smaller in the Tet group than that in the control group (1526 vs. 2306, p=0.001), and the size was stable in the Tet group (1568 vs. 1526, p= 0.381), while progressed significantly in the control group (2055 vs. 2306, p=0.000). The small nodule profusion and emphysema were also milder than that in the control group (6.0 vs. 7.5, p=0.046 and 8.0 vs. 12, p=0.016 respectively). Pulmonary ventilation function parameters FVC and FEV1 improved in the Tet group (3222 vs. 3301, p=0.021; 2202 vs. 2259, p=0.025 respectively) and decreased in the control group (3272 vs. 3185, p= 0.00; 2094 vs. 1981, p=0.00 respectively). FEV1/FVC was also significantly higher in the Tet group than that in the control group (68.45vs. 60.74, p=0.001). However, similar result was failed to observed for DLco%, which showed a significant decrease in both groups. CONCLUSION: Tet has shown great potential in the treatment of PMF by slowing the progression of pulmonary fibrosis and the decline of lung function.

Identification of tumor immunophenotypes associated with immunotherapy response in bladder cancer.

OBJECTIVES: This study aims to reveal immunophenotypes associated with immunotherapy response in bladder cancer, identify the signature genes of immune subtypes, and provide new molecular targets for improving immunotherapy response. METHODS: Bladder cancer immunophenotypes were characterized in the bulk RNA sequencing dataset GSE32894 and Imvigor210, and gene expression signatures were established to identify the immunophenotypes. Expression of gene signatures were validated in single-cell RNA sequencing dataset GSE145140 and human proteins expression data source. Investigation of Immunotherapy Response was performed in IMvigor210 dataset. Prognosis of tumor immunophenotypes was further analyzed. RESULTS: Inflamed and immune-excluded immunophenotypes were characterized based on the tumor immune cell scores. Risk score models that were established rely on RNA sequencing profiles and overall survival of bladder cancer cohorts. The inflamed tumors had lower risk scores, and the low-risk tumors were more likely to respond to atezolizumab, receiving complete response/partial response (CR/PR). Patients who responded to atezolizumab had higher SRRM4 and lower NPHS1 and TMEM72 expression than the non-responders. SRRM4 expression was a protective factor for bladder cancer prognosis, while the NPHS1 and TMEM72 showed the opposite pattern. CONCLUSION: This study provided a novel classification method for tumor immunophenotypes. Bladder cancer immunophenotypes can predict the response to immune checkpoint blockade. The immunophenotypes can be identified by the expression of signature genes.

Treatment of obstructive sleep apnea with a simple CPAP device.

PURPOSE: CPAP is the "gold standard" treatment for obstructive sleep apnea (OSA). Current CPAP models have developed additional functions including automatic CPAP and pressure relief. However, CPAP adherence has not improved over the last three decades. Many patients in low-income countries cannot afford these CPAP devices. A novel simple CPAP device with a fixed pressure without pressure controller was developed. METHODS: Manual CPAP pressure titration was performed in 127 patients with OSA. Six patients with a titration pressure higher than 11 cmH2O and 14 patients who could not tolerate CPAP were excluded, leaving 107 participating in the following 2 studies. In study one, 54 of 107 patients were treated by both conventional fixed CPAP and simple CPAP in random order. In the second study, another 53 patients were treated by both autoCPAP in automatic function and simple CPAP in random order. Simple CPAP was fixed at 10 cmH2O, 8 cmH2O, and 6 cmH2O for patients whose titration pressure was between 9-10, 7-8, and ≤ 6 cmH2O, respectively. Conventional fixed CPAP device was set exactly the same as manual titration pressure. RESULTS: All patients whose manual titration pressure ≤ 10 cmH2O were effectively treated by simple CPAP (AHI 40.7 ± 2.3 events/h before vs 2.5 ± 0.3 events/h after, p < 0.001). Patients expressed similar preferences for simple CPAP, autoCPAP, and conventional fixed CPAP (p > 0.05). CONCLUSIONS: We conclude that a novel simple CPAP is an alternative treatment for most patients with OSA, which may widen access to CPAP therapy in the developing countries because of its low cost.

Strategy of Electrolyte Design: Triethanolamine as a Polydentate Ligand to Improve Solvation of Zinc in Zinc-Air Batteries.

The zinc-air batteries (ZABs) are regarded as the most potential energy storage device for the next generation. However, the zinc anode passivation and hydrogen evolution reaction (HER) in alkaline electrolyte situations inhibit the zinc plate working efficiency, which needs to improve zinc solvation and better electrolyte strategy. In this work, we propose a design of new electrolyte by using a polydentate ligand to stabilize the zinc ion divorced from the zinc anode. The formation of the passivation film is suppressed greatly, compared to the traditional electrolyte. The characterization result presents that the quantity of the passivation film is reduced to nearly 33% of pure KOH result. Besides, triethanolamine (TEA) as an anionic surfactant inhibits the HER effect to improve the efficiency of the zinc anode. The discharging and recycling test indicates that the specific capacity of the battery with the effect of TEA is improved to nearly 85 mA h/cm2 compared to 0.21 mA h/cm2 in 0.5 mol/L KOH, which is 350 times the result of the blank group. The electrochemical analysis results also indicate that zinc anode self-corrosion is palliated. With density function theory, calculation results prove the new complex existence and structure in electrolytes by the data of the molecular orbital (highest occupied molecular orbital-lowest unoccupied molecular orbital). A new theory of multi-dentate ligand inhibiting passivation is elicited and provides a new direction for ZABs' electrolyte design.

Increased D-dimer level was a poor predictor of neuroblastoma, especially in the high-risk group.

PURPOSE: D-dimer levels are associated with tumor progression and prognosis in various cancers. However, there are few research about the relationship between D-dimer and neuroblastoma (NB). This study assessed the relationships of D-dimer levels with clinical features and overall survival (OS) in patients with NB. METHODS: Information about the clinical features of 365 patients and the prognosis of 301 patients was collected. The relationship between D-dimer levels and clinical features or OS was analyzed. We constructed the risk score based on Cox regression analysis and verified the predictive efficacy of the model through ROC curve and calibration curve. RESULTS: The results showed that D-dimer levels were significantly increased in patients with nonmediastinal tumor, tumor larger than 10 cm, stage 3-4 disease, bone marrow metastasis, unfavorable histology, bone metastasis, NMYC amplification, and the high-risk group (all P < 0.05). The Kaplan-Meier survival analysis showed that there were significant differences in 3- and 5-year OS (87.4% vs. 32.3%, 79.3% vs. 32.3%, P < 0.0001) between the low D-dimer and high D-dimer groups. In the high-risk group, the OS of high D-dimer was significantly lower than that of low D-dimer (P < 0.0001). All cases were divided into the training cohort (N = 211) and the validation cohort (N = 90). Multivariate analysis further suggested that D-dimer level, bone metastasis, and NMYC status were independent prognostic factors for OS (all P < 0.05). Based on the above three factors, we constructed the risk score in the training cohort. Survival analysis showed that compared with the other groups, the group with 11 scores had the worst prognosis (3-year OS 0%, P < 0.0001). The time-dependent ROC analysis and calibration curve indicated that the risk score had good accuracy. CONCLUSIONS: Patients with high D-dimer levels tended to have unfavorable clinical characteristics and poor prognosis.

Preoperative Systemic Inflammatory Markers as a Significant Prognostic Factor After TURBT in Patients with Non-Muscle-Invasive Bladder Cancer.

Introduction: Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) have been widely proposed to have predictive value for the patient prognosis of many malignancies, including bladder cancer. However, the predictive value of their combination in non-muscle-invasive bladder cancer (NMIBC) is unclear. Methods: Cases of NMIBC patients who underwent transurethral resection of the bladder tumor were recruited from two tertiary public medical centers. A systemic inflammatory marker (SIM) score was calculated based on comprehensive consideration of NLR, PLR, and LMR. Recurrence-free survival (RFS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. The Log rank test was used to compare differences between the groups. Cox regression was used to screen risk factors affecting RFS and PFS. Nomogram models were established and validated, and patients were stratified based on the model scores. Results: The study dataset was grouped according to a 7:3 randomization, with the training cohort consisting of 292 cases and the validation cohort consisting of 124 cases. Cox regression analysis showed that SIM score is an independent predictor of RFS and PFS in NMIBC patients. The novel models were established based on the SIM score and other statistically significant clinicopathological features. The area under the curve (AUC) for predicting 1-, 2-, and 3-year RFS was 0.667, 0.689, and 0.713, respectively. The AUC for predicting 1-, 2-, and 3-year PFS was 0.807, 0.775, and 0.862, respectively. Based on the risk stratification, patients at high risk of recurrence and progression could be accurately identified. The established models were applied to the patient evaluation of the validation cohort, which proved the great performance of the novel models. Conclusion: The novel models based on the SIM score and clinicopathological characteristics can accurately predict the survival prognosis of NMIBC patients, and the models can be used by clinicians for individualized patient assessment and to assist in clinical decision-making.

Preoperative systemic immune-inflammation index as a significant prognostic factor after TURBT in patients with non-muscle-invasive bladder cancer: A retrospective study based on propensity score matching analysis.

OBJECTIVE: To investigate the association of the preoperative systemic immune-inflammation index (SII) with recurrence-free survival (RFS) after transurethral resection of the bladder tumor (TURBT) of non-muscle-invasive bladder cancer (NMIBC) using propensity score matching (PSM) analysis. METHODS: The clinicopathological characteristics and follow-up data of NMIBC patients were collected retrospectively from two tertiary medical centers. A 1:1 PSM analysis was carried out using the nearest-neighbor method (caliper size: 0.02). Cox regression analysis was used to identify the risk factors associated with RFS. RESULTS: A total of 416 NMIBC patients were included in this study. Before and after matching, patients with increased SII had worse RFS (p < 0.0001 and p = 0.027, respectively). Multivariate Cox analysis identified SII as an independent predictor of RFS before (HR [95% CI]: 1.789 [1.232, 2.599], p = 0.002) and after matching (HR [95% CI]: 1.646 [1.077, 2.515], p = 0.021). In the matched subgroup analysis, an elevated SII had a significant association with postoperative worse RFS in the T1 stage (p = 0.025), primary status (p = 0.049), high-grade (p = 0.0015), and multiple lesions (p = 0.043) subgroups. CONCLUSION: SII could accurately stratify the prognosis of NMIBC patients before and after PSM analysis. An elevated SII was significantly associated with worse RFS in NMIBC patients.

Development and external validation of a novel nomogram model for predicting postoperative recurrence-free survival in non-muscle-invasive bladder cancer.

Background: Transurethral resection of the bladder tumor with or without adjuvant intravesical instillation (IVI) has been the standard treatment for non-muscle-invasive bladder cancer (NMIBC), whereas a high percentage of patients still experience local tumor recurrence and disease progression after receiving the standard treatment modalities. Unfortunately, current relevant prediction models for determining the recurrent and progression risk of NMIBC patients are far from impeccable. Methods: Clinicopathological characteristics and follow-up information were retrospectively collected from two tertiary medical centers between October 2018 and June 2021. The least absolute shrinkage and selection operator (LASSO) and Cox regression analysis were used to screen potential risk factors affecting recurrence-free survival (RFS) of patients. A nomogram model was established, and the patients were risk-stratified based on the model scores. Both internal and external validation were performed by sampling the model with 1,000 bootstrap resamples. Results: The study included 299 patient data obtained from the Affiliated Hospital of Xuzhou Medical University and 117 patient data obtained from the First Affiliated Hospital of Guangxi Medical University. Univariate regression analysis suggested that urine red blood cell count and different tumor invasion locations might be potential predictors of RFS. LASSO-Cox regression confirmed that prior recurrence status, times of IVI, and systemic immune-inflammation index (SII) were independent factors for predicting RFS. The area under the curve for predicting 1-, 2-, and 3-year RFS was 0.835, 0.833, and 0.871, respectively. Based on the risk stratification, patients at high risk of recurrence and progression could be accurately identified. A user-friendly risk calculator based on the model is deposited at https://dl0710.shinyapps.io/nmibc_rfs/. Conclusion: Internal and external validation analyses showed that our model had excellent predictive discriminatory ability and stability. The risk calculator can be used for individualized assessment of survival risk in NMIBC patients and can assist in guiding clinical decision-making.

Prediction to the prognosis of children with neuroblastoma by nomogram based on the first-diagnosed inflammatory markers.

BACKGROUND: Patients with high-risk neuroblastoma (NB) have a poor prognosis. The prognostic significance of inflammatory biomarker-based nomograms for children with NB has not been previously studied. METHODS: Part of patients diagnosed with NB in our center from January 2016 to March 2022 were included in the study. Inflammatory biomarkers were primary outcome measures, including C-reactive protein (CRP), ferritin, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Univariate and multivariate survival analyses were performed to assess the prognostic value of these indicators for overall survival (OS) in NB children, showing the Kaplan-Meier survival curves and plotting the nomogram. C-index were used to detect predictability. RESULTS: 93 NB patients were retrospectively analyzed. CRP, ferritin, NLR, PLR, and SII were significantly associated with OS of NB patients, while LMR were found to be not predictive of OS for NB patients. The established nomogram is well-calibrated, and the C-index is 0.731. CONCLUSION: Survival analysis found part of inflammatory biomarkers related to the prognosis of NB. The nomogram could be used as a convenient predictive tool in clinical practice to evaluate the prognosis of NB children at first diagnosis.

Expression of ADRB2 in children with neuroblastoma and its influence on prognosis.

Objective: Neuroblastoma (NB), originating from sympathetic spinal tissue, is a serious threat to the life of children. Especially in the high-risk group, an overall five-year survival rate less than 50% indicates an extremely poor clinical outcome. Here, the expression the of ß-2 adrenergic (ADRB2) receptor gene in tumor tissues of children with NB was detected and the correlation between its expression and clinical characteristics and prognosis was analyzed. Methods: Forty-five tumor tissue samples and forty-eight paraffin sections of NB were obtained from Children's Hospital of Chongqing Medical University from 2015 to 2021. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was utilized to detect the expression of ADRB2 at the mRNA level and immunohistochemistry (IHC) at the protein level. Results: For the RT-qPCR, the analysis showed that the expression of ADRB2 in the high-risk group was significantly lower (P = 0.0003); in addition, there were also statistically significant differences in Shimada classification (P = 0.0025) and N-MYC amplification (P = 0.0011). Survival prognosis analysis showed that the prognosis was better with high ADRB2 expression (P = 0.0125), and the ROC curve showed that ADRB2 has a certain accuracy in predicting prognosis (AUC = 0.707, CI: 0.530-0.884). Moreover, the expression of ADRB2, N-MYC amplification and bone marrow metastasis were the factors that independently affected prognosis, and at the protein level, the results showed that the differential expression of ADRB2 was conspicuous in risk (P = 0.0041), Shimada classification (P = 0.0220) and N-MYC amplification (P = 0.0166). In addition, Kaplan-Meier curves showed that the prognosis in the group with high expression of ADRB2 was better (P = 0.0287), and the ROC curve showed that the score of ADRB2 had poor accuracy in predicting prognosis (AUC = 0.662, CI: 0.505-0.820). Conclusion: ADRB2 is a protective potential biomarker and is expected to become a new prognostic biomolecular marker of NB.

Single-cell landscape analysis reveals distinct regression trajectories and novel prognostic biomarkers in primary neuroblastoma.

Neuroblastoma (NB), which is the most common pediatric extracranial solid tumor, varies widely in its clinical presentation and outcome. NB has a unique ability to spontaneously differentiate and regress, suggesting a potential direction for therapeutic intervention. However, the underlying mechanisms of regression remain largely unknown, and more reliable prognostic biomarkers are needed for predicting trajectories for NB. We performed scRNA-seq analysis on 17 NB clinical samples and three peritumoral adrenal tissues. Primary NB displayed varied cell constitution, even among tumors of the same pathological subtype. Copy number variation patterns suggested that neuroendocrine cells represent the malignant cell type. Based on the differential expression of sets of related marker genes, a subgroup of neuroendocrine cells was identified and projected to differentiate into a subcluster of benign fibroblasts with highly expressed CCL2 and ZFP36, supporting a progressive pathway of spontaneous NB regression. We also identified prognostic markers (STMN2, TUBA1A, PAGE5, and ETV1) by evaluating intra-tumoral heterogeneity. Lastly, we determined that ITGB1 in M2-like macrophages was associated with favorable prognosis and may serve as a potential diagnostic marker and therapeutic target. In conclusion, our findings reveal novel mechanisms underlying regression and potential prognostic markers and therapeutic targets of NB.

Machine learning model for the prediction of prostate cancer in patients with low prostate-specific antigen levels: A multicenter retrospective analysis.

Objective: The aim of this study was to develop a predictive model to improve the accuracy of prostate cancer (PCa) detection in patients with prostate specific antigen (PSA) levels ≤20 ng/mL at the initial puncture biopsy. Methods: A total of 146 patients (46 with Pca, 31.5%) with PSA ≤20 ng/mL who had undergone transrectal ultrasound-guided 12+X prostate puncture biopsy with clear pathological results at the First Affiliated Hospital of Guangxi Medical University (November 2015 to December 2021) were retrospectively evaluated. The validation group was 116 patients drawn from Changhai Hospital(52 with Pca, 44.8%). Age, body mass index (BMI), serum PSA, PSA-derived indices, several peripheral blood biomarkers, and ultrasound findings were considered as predictive factors and were analyzed by logistic regression. Significant predictors (P < 0.05) were included in five machine learning algorithm models. The performance of the models was evaluated by receiver operating characteristic curves. Decision curve analysis (DCA) was performed to estimate the clinical utility of the models. Ten-fold cross-validation was applied in the training process. Results: Prostate-specific antigen density, alanine transaminase-to-aspartate transaminase ratio, BMI, and urine red blood cell levels were identified as independent predictors for the differential diagnosis of PCa according to multivariate logistic regression analysis. The RandomForest model exhibited the best predictive performance and had the highest net benefit when compared with the other algorithms, with an area under the curve of 0.871. In addition, DCA had the highest net benefit across the whole range of cut-off points examined. Conclusion: The RandomForest-based model generated showed good prediction ability for the risk of PCa. Thus, this model could help urologists in the treatment decision-making process.

GPER mediates the IL6/JAK2/STAT3 pathway involved in VEGF expression in swine ovary GCs.

Vascular endothelial growth factor (VEGF) plays a pivotal role in angiogenesis in ovaries, particularly during follicular development and ovulation. Interleukin-6 (IL-6) is one of the major pro-inflammatory factors that are involved in the angiogenesis process physiologically and pathologically. Previous studies have shown that 17ß-estradiol (E2) stimulates VEGF expression by upregulating hypoxia-inducible factor 1α (HIF-1α) in many cell types, and the high level of E2 causes an inflammatory-like microenvironment before ovulation. However, whether IL-6 signaling is involved in E2-regulating VEGF expression in swine granulosa cells (GCs) is still unknown. In this study, we found the estrogen membrane receptor, G-protein-coupled estrogen receptor 1 (GPER), was expressed in swine GCs, and the expression level of GPER, HIF-1α, and VEGF increased with follicular development. In vitro study showed that E2, ICI182780, and GPER agonist (G1) promoted the expressions of HIF-1α and VEGF in swine GCs, while GPER antagonist (G15) inhibited the stimulating effect of E2 and G1. Meanwhile, G15 inhibited the stimulating effect of E2 and G1 on IL-6 mRNA expression and secretion. Furthermore, IL-6 antibody and AG490 (JAK2/STAT3 inhibitor) attenuated G1-induced HIF-1α and VEGF expression. In conclusion, this study revealed how estrogen-induced HIF-1α and VEGF expressions in swine GCs are mediated through GPER-derived IL-6 secretion leading to JAK2/STAT3 activation.

A PVA/LiCl/PEO interpenetrating composite electrolyte with a three-dimensional dual-network for all-solid-state flexible aluminum-air batteries.

Aluminum-air batteries are promising electronic power sources because of their low cost and high energy density. However, traditional aluminum-air batteries are greatly restricted from being used in the field of flexible electronics due to the rigid battery structure, and the irreversible corrosion of the anode by the alkaline electrolyte, which greatly reduces the battery life. To address these issues, a three-dimensional dual-network interpenetrating structure PVA/LiCl/PEO composite gel polymer electrolyte (GPE) is proposed. The gel polymer electrolyte exhibits good flexibility and high ionic conductivity (σ = 6.51 × 10-3 S cm-1) at room temperature. Meanwhile, benefiting from the high-performance GPE, an assembled aluminum-air coin cell shows a highest discharge voltage of 0.73 V and a peak power density (P max) of 3.31 mW cm-2. The Al specific capacity is as high as 735.2 mA h g-1. A flexible aluminum-air battery assembled using the GPE also performed stably in flat, bent, and folded states. This paper provides a cost-effective and feasible way to fabricate a composite gel polymer electrolyte with high performance for use in flexible aluminum-air batteries, suitable for a variety of energy-related devices.

Mechanical modeling of pimple growth.

Pimple is one of the most common skin diseases for humans, whose growth cause pain yet the corresponding mechanical analysis is lacking. A finite element model is developed to quantify the deformation field with the expansion of follicle, and then the mechanical stimulus is related to the sensation of pain during the development of pimple. Parametric studies show the dependence of mechanical stimulus and pain level on the pimple-surrounded structures, follicle depth and mechanical properties of the epidermis. The findings in this paper may provide useful insights on prevention or pain mitigation of pimples, as well as those related to other tissue growth and respective cosmetic concerns.

Palonosetron is nonsuperior to ondansetron in acute phase but provides superior antiemetic control in delayed phase for pediatric patients administered highly emetogenic chemotherapy.

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) in children remains to be a major side effect despite antiemetic treatment. Palonosetron is a new generation 5-HT3 receptor antagonists effective against acute and delayed nausea and vomiting. This study aimed to compare the therapeutic values of palonosetron and ondansetron in preventing pediatric CINV. METHODS: A prospective, randomized, double-blind, parallel controlled study was conducted in 0-18 years old cancer patients administered highly emetogenic chemotherapy, with different dosage of palonosetron or ondansetron, both followed by dexamethasone. The patients were observed for vomiting and nausea from 0 to 120 hr after chemotherapy initiation. All adverse events (AEs) during the study period were recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-TRC-14004891. RESULTS: Between August 2014 and July 2016, 565 patients were randomly assigned to receive 5 µg/kg palonosetron (n = 185), 10 µg/kg palonosetron (n = 186), and 3 × 150 µg/kg ondansetron (n = 194), of whom 181, 185, and 189, respectively, were included in the efficacy analysis. Complete response (CR) rates during the acute phase were 69.1, 69.7, and 64.6%, respectively, in the 5 µg/kg palonosetron, 10 µg/kg palonosetron, and ondansetron groups. In the delayed phase, 10 µg/kg palonosetron (CR, 53.5%) showed superiority to 5 µg/kg palonosetron (CR, 39.8%) and ondansetron (CR, 32.8%) groups (P < 0.05). The most frequently observed drug-related AEs were nervous system disorders, mainly headache, with an incidence of 2.8, 2.2, and 2.6% in each group, respectively. CONCLUSION: Combination of palonosetron plus dexamethasone is highly effective in controlling acute and delayed CINV, with palonosetron superior to ondansetron.

A high-vacuum wound drainage system reduces pain and length of treatment for pediatric soft tissue abscesses.

Open incision and drainage (I&D) and wound packing is accepted as the standard treatment for soft tissue abscesses. However, conventional I&D has a number of problems in practice which prompt us to improve the I&D methods that would minimize the pain associated with packing during dressing changes. In order to compare the pain associated with dressing changes in the conventional I&D group to the vacuum system group and the treatment time of both groups, we performed a randomized trial in pediatric patients between 0 and 18 years of age who are undergoing abscess drainage in the operating room from April 2011 to April 2015. Patients treated with open I&D (n = 648) were compared to those treated with placement of high-vacuum wound drainage system (n = 776) through the abscess cavities. Both groups received equivalent antibiotic treatment, and all patients were followed up in the outpatient clinics until the infection has been resolved. The mean FACES scale pain scores were significantly higher in the open I&D group than in the vacuum system group. The vacuum system group had a shorter length of stay and less need for community doctor or outpatient dressing changes than the open I&D group (p < 0.001). No recurrent abscesses were observed in the vacuum system group, and 10 patients in the open I&D group required another drainage at the exact same location. CONCLUSION: High-vacuum wound drainage system was an efficient and safe alternative to the traditional I&D for community-acquired soft tissue abscesses with few complications in short term. What is Known: • Open incision and drainage (I&D) followed by irrigation and wound packing is the standard treatment for soft tissue abscesses. • The painful daily packing may cause emotional trauma to the child and lead to an unwelcoming challenge to the caretakers and health care providers. What is New: • We modified the method of I&D by adding primary suturing of the wound and placement of a high-vacuum wound drainage system. • This technique was proved to be an efficient and safe alternative to the traditional I&D method for soft tissue abscesses with small complications in short term.

Intermittent Fever, Progressive Weight Gain, and Personality Changes in a Five-Year-Old Girl: Unusual Paraneoplastic Syndrome due to Presacral Ganglioneuroma.

Ganglioneuromas are rare tumors in the neuroblastoma group. Paraneoplastic syndrome (PNS) due to presacral ganglioneuromas was hardly reported in previous literature. Here, we reported that a case of a 5-year-old girl with a presacral ganglioneuroma presented with PNS, who presented with intermittent fever, progressive weight gain, and personality changes. Our report revealed intermittent fever, progressive weight gain, and personality changes may represent rare paraneoplastic syndromes in ganglioneuromas.

Synthesis and structures of cycloalkylidene-bridged cyclopentadienyl metallocene catalysts: effects of the bridges of ansa-metallocene complexes on the catalytic activity for ethylene polymerization.

A series of cycloalkylidene-bridged cyclopentadienyl metallocene complexes, [(CH(2))(n)C(C(5)H(4))(2)MCl(2)] (M = Ti, n = 4 (4), 5 (5), 6 (6); M = Zr, n = 4 (7), 5 (8), 6 (9); M = Hf, n = 4 (10), 5 (11), 6 (12)), have been synthesized and applied to ethylene polymerization after activation with methyl aluminoxane (MAO). The cycloalkylidene-bridged titanocene catalysts exhibit much higher activities than the corresponding zirconocene and hafnocene analogues, and have the highest activities at higher temperatures. In comparison, the silacyclopentylidene-bridged metallocene complexes [(CH(2))(4)Si(C(5)H(4))(2)MCl(2)] (M = Ti (13), Zr (14)) and isopropylene-bridged metallocene complexes [Me(2)C(C(5)H(4))(2)MCl(2)] (M = Ti (15), Zr (16)) have also been synthesized and applied to ethylene polymerization. In both cases, the titanocene complexes show much higher activities than the corresponding zirconocene analogues, especially at a lower temperature. The molecular structures of complexes 4-9 have been determined by X-ray diffraction. The structure-activity relationships, especially the effects of the bridges of ansa-metallocene complexes, are discussed.