Balloon dilation for failed pyeloplasty in children?

ABSTRACT Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

Balloon dilation for failed pyeloplasty in children?

OBJECTIVE: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. MATERIALS AND METHODS: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. RESULTS: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. CONCLUSIONS: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

Photosynthetic production of wheat under precision planting patterns in northern china / Produção fotossintética de trigo através de padrões de plantação de precisão no norte da china

Winter wheat (Triticum aestivum) is cultivated across a wide region; however, water is scarce during the growing season of wheat in the Northern Plain of China. Therefore, winter wheat should be irrigated to maintain a stable and high grain yield. The aim of this field study was to develop a water-conserving precision planting pattern for winter wheat that is grown in the Northern China Plain with the purpose of exploring the benefits in maintaining water and effects on wheat productivity. To accomplish this, several production variables and photosynthetic indexes were measured, including the number of stems, the leaf area index (LAI), photosynthetically available radiation (PAR), net photosynthetic rate, and grain yield. The study was carried out during the 2011­2012 and 2012­2013 winter wheat growing seasons. The experiment included a double-row planting pattern (DRPP) and a single-row planting pattern (SRPP), both of which were either irrigated or rainfed. The area of each plot was 9 m2, and the experimental design was a randomized blocks design with three replicates. All results were analyzed with an ANOVA, the F test, and the LSD (p 0.05) for means comparison. PAR capture ratios in the DRPP were higher than those in the SRPP at 50­120 cm above the ground. The photosynthetic traits of flag leaves under irrigated conditions were not significantly influenced by the respective planting pattern. However, at a growth stage of 80 under the rainfed conditions, the mean photosynthetic rate within flag leaves in the DRPP was higher than that in the SRPP. Furthermore, the DRPP under rainfed conditions was more likely to increase the apparent quantum yield (AQY) of flag leaves than the yield obtained under irrigation. These results suggest that DRPP optimizes the canopy PAR distribution in winter wheat and contributes to the maintenance of a higher photosynthetic capacity in the flag leaves under water stress (the rainfed condition). This relationship may be applied in demonstration trials to encourage winter wheat farmers to incorporate the use of DRPP in the drought-prone areas, which are subjected to insufficient precipitation during the growing stage of wheat in Northern China.

O trigo de inverno (Triticum aestivum) é cultivado em uma vasta região; no entanto, a água é escassa durante a estação de crescimento do trigo na Planície do Norte da China. Assim, o trigo de inverno deve ser irrigado para manter um rendimento de grãos estável e elevado. O objetivo deste trabalho de campo foi o de desenvolver um padrão de plantação de precisão que conserve a água para o trigo de inverno que é cultivado na Planície do Norte da China com o propósito de explorar os benefícios da retenção de água e os efeitos na produtividade do trigo. Para isso, diversas variáveis de produção e índices fotossintéticos foram medidos, incluindo o número de hastes, o índice de área da folha (do inglês, LAI - leaf area index), a radiação fotossinteticamente disponível (do inglês, PAR - photosynthetically available radiation), taxa fotossintética líquida e o rendimento de grãos. O estudo foi conduzido durante as estações de crescimento do trigo de inverno em 2011-2012 e 2012-2013. O experimento incluiu um padrão de plantação em fila dupla (do inglês, DRPP - double-row planting pattern) e um padrão de plantação em fila única (do inglês, SRPP - single-row planting pattern), em ambos os casos ou foram irrigados artificialmente ou através da chuva (regadio e sequeiro). A área de cada lote de terra foi de 9 m2, e o delineamento experimental foi um de blocos aleatórios com três repetições. Todos os resultados foram analisados com uma ANOVA, um teste F, e um LSD (p 0.05) para a comparação das médias. As taxas de captura de PAR no DRPP foram maiores do que aquelas no SRPP a 50-120 cm acima do solo. As características fotossintéticas das folhas-bandeira (do inglês, flag leaves) sob condições de irrigação artificial não foram significativamente influenciadas pelo respectivo padrão de plantação. No entanto, num estágio de crescimento de 80% abaixo das condições de irrigação pela chuva, a taxa fotossintética média dentre as folhas-bandeira no DRPP foi maior que aquela observada no SRPP. Além disso, o DRPP sob condições de irrigação pela chuva foi mais suscetível ao aumento do rendimento quântico aparente (do inglês, AQY - apparent quantum yield) das folhas-bandeira do que o rendimento obtido através da irrigação artificial. Estes resultados sugerem que o DRPP otimiza a distribuição PAR do dossel no trigo de inverno e contribui para a manutenção de uma maior capacidade fotossintética nas folhas bandeira sob estresse hídrico (a condição de sequeiro). Esta relação pode ser aplicada em ensaios de demonstração para encorajar os agricultores de trigo de inverno a incorporar o uso do DRPP em áreas propensas à seca, que estão submetidas a precipitação insuficiente durante a fase de crescimento do trigo no Norte da China.

Risk of Congestive Heart Failure in Early Breast Cancer Patients Undergoing Adjuvant Treatment With Trastuzumab: A Meta-Analysis.

BACKGROUND: The use of trastuzumab has proven to be a successful strategy in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer; however, it is associated with an increased risk of cardiac dysfunction. We performed an up-to-date, comprehensive meta-analysis to clarify the risk of congestive heart failure (CHF) in patients with early breast cancer receiving different durations of adjuvant trastuzumab with the longest-term follow-up. METHODS: Eligible studies included randomized control trials of HER2-positive early breast cancer patients with or without trastuzumab in adjuvant chemotherapy. Adequate reporting of CHF data were required for inclusion. Statistical analyses were conducted to calculate the overall incidence, relative risk (RR), and 95% confidence interval (CI) by use of a fixed-effects model. RESULTS: Six randomized control trials including 18,111 patients were identified. The overall incidence of high-grade CHF in patients treated with trastuzumab versus placebo was 1.44% (95% CI, 0.79%-2.64%) and the RR was 3.19 (95% CI, 2.03-5.02; p < .00001). In subgroup analysis, the difference in CHF incidence failed to achieve significance. The RR for 8 mg/kg trastuzumab (high dose) was greater than that for 4 mg/kg (low dose) (RR, 6.79, 95% CI, 2.03-22.72, p = .0001; versus RR, 2.64; 95% CI, 1.61-4.32; p = .002). Additionally, higher RRs were observed for patients receiving trastuzumab for 1 year (RR, 3.29; 95% CI, 2.07-5.25) and 2 years (RR, 9.54; 95%CI, 2.19-41.43), but not 9 weeks (RR, 0.50; 95% CI, 0.05-5.49) compared with control groups. No evidence of publication bias was observed. CONCLUSION: Adjuvant trastuzumab therapy was strongly associated with an increased risk of significant CHF in patients with early breast cancer, particularly in 2-year use. IMPLICATIONS FOR PRACTICE: This comprehensive meta-analysis evaluated the risk of congestive heart failure with a usage profile of adjuvant trastuzumab in patients with early breast cancer. Before initiating treatment with trastuzumab, a risk-benefit analysis for individual patients should be critically evaluated, considering that the prognosis is closely related to drug dose and duration of use. Cardiac function should be monitored throughout the treatment period and also during follow-up. Thus, early identification of trastuzumab-related cardiac dysfunction can allow effective medical intervention, elimination of symptoms, recovery of function, and continuation of trastuzumab therapy.