Preoperative high-intensity strength training combined with balance training can improve early outcomes after total knee arthroplasty.

BACKGROUND: To investigate the effect of preoperative high-intensity strength training combined with balance training on the knee function of end-stage knee osteoarthritis (KOA) patients after total knee arthroplasty (TKA). METHODS: A prospective study was conducted on end-stage KOA patients awaiting TKA. The patients were divided into an experimental group and a control group according to whether they received a preoperative training intervention. The differences in knee flexor-extensor strength, knee range of motion (ROM), timed up and go (TUG) test result, stair ascend/descend test result, Knee Society score (KSS) and Berg balance scale (BBS) score were assessed in both groups at baseline (T1), before operation (T2), 3 months after operation (T3), and 1 year after operation (T4). RESULTS: After high-intensity strength training and balance training, the knee flexor-extensor strength, TUG test result, stair ascend/descend test result, and KSS were all significantly improved at T2 in the experimental group over the control group. At T3, the knee ROM, knee flexor-extensor strength, TUG test result, BBS score, and KSS clinical and functional scores were all significantly superior in the experimental group. The experimental group enjoyed a superiority in KSS clinical and functional scores until T4. Group × time and between-group interactions were found in all assessment indicators in both groups (p < 0.01). CONCLUSION: Preoperative high-intensity strength training combined with balance training can enhance the knee flexor-extensor strength and balance of patients with end-stage KOA in the short term and help improve early outcomes after KOA. Trial registration ChiCTR2000032857, 2020-05-13.

[Forecasting of Emission Co-reduction of Greenhouse Gases and Pollutants for the Road Transport Sector in Lanzhou Based on the LEAP Model].

With the continuous increase in transportation activities, the transportation sector has become an important source of global greenhouse gases. In 2019, road vehicles accounted for nearly three-quarters of the CO2 emissions of the entire transportation sector and will be the key to achieving carbon peaks in the transportation sector. At the same time, air pollutants emitted by road vehicles are also one of the threats to the environment and human health. Based on the long-range energy alternatives planning system (LEAP) model, we constructed the baseline (BAU) scenario, low-carbon (LC) scenario, and enhanced low-carbon (ELC) scenario for the development of the road transport sector in Lanzhou from 2015 to 2040 and simulated energy consumption and emission co-reduction of greenhouse gases and pollutants under policies and measures. The results showed that the energy consumption and CO2 emissions of the LC scenario will peak in 2026, whereas those in the ELC scenario will peak in 2020. In these two scenarios, pollutant emissions such as NOx, CO, HC, PM2.5, and PM10 began to decline sharply between 2015 and 2017, and the downward trend will slow down gradually around 2023. Based on the feasibility of measures and the cost of abatement, the LC scenario can be used as a road vehicle carbon peak scenario in Lanzhou. In this scenario, the reduction rates of energy consumption, CO2, NOx, CO, HC, PM2.5, and PM10 emissions will reach -24.17%, -26.57%, -55.38%, -65.91%, -72.87%, -76.66%, and -77.18% compared with those under the BAU scenario by 2040. At present, the road vehicles in Lanzhou City should focus on structural optimization measures such as clean-energy use of public transportation, electrification of small passenger cars, and phasing out old cars, as well as vigorously promoting low-carbon travel and improving energy efficiency accompanying the development of automotive technology. These efforts will effectively control CO2 and pollutant emissions by road vehicles, and carbon peaks will be achieved as soon as possible. In addition, it is necessary to pay attention to the changes in vehicle types during the implementation of these measures, which most contribute CO2 and various pollutants, in order to make the measures more targeted by changing the number or the market share of new energy of focused vehicle types.

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.

An unusual cause of paediatric abdominal pain: Mesenteric masses accompanied with volvulus.

BACKGROUND/AIMS: Volvulus caused by mesenteric masses is rare and may result in serious consequences. This study aimed to better characterize volvulus caused by mesenteric masses in children. MATERIALS AND METHODS: A retrospective study was conducted in 24 patients who underwent surgical treatment between January 1994 and January 2014 in one single institution. RESULTS: There were 10 boys and 14 girls. The most frequent findings were abdominal pain (100%), emesis (91.7%) and nausea (83.3%). Physical examination showed positive ileus signs in majority cases, and palpable mass was found in half of the patients. Ultrasound and CT scans revealed mesenteric masses in 21 and 24 patients, and 'whirlpool sign' was observed in 19 and 22 patients, respectively. Emergency laparotomy was performed in all patients. Histological examination revealed that 18 cystic masses were lymphangioma, 5 solid cases were lipoma and the remaining one was lipoblastoma. The postoperative course was uneventful in 22 patients, and postoperative obstruction and incision infection occurred in 2 patients. There was no evidence of recurrence at follow-up. CONCLUSION: Volvulus caused by mesenteric masses is a rare but potentially life-threatening cause of abdominal pain, which should be considered in the differential diagnosis of paediatric acute abdominal pain.

The myelinated fiber loss in the corpus callosum of mouse model of schizophrenia induced by MK-801.

Previous magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) investigations have shown that the white matter volume and fractional anisotropy (FA) were decreased in schizophrenia (SZ), which indicated impaired white matter integrity in SZ. However, the mechanism underlying these abnormalities has been less studied. The current study was designed to investigate the possible reasons for white matter abnormalities in the mouse model of SZ induced by NMDA receptor antagonist using the unbiased stereological methods and transmission electron microscope technique. We found that the mice treated with MK-801 demonstrated a series of schizophrenia-like behaviors including hyperlocomotor activity and more anxiety. The myelinated fibers in the corpus callosum (CC) of the mice treated with MK-801 were impaired with splitting lamellae of myelin sheaths and segmental demyelination. The CC volume and the total length of the myelinated fibers in the CC of the mice treated with MK-801 were significantly decreased by 9.4% and 16.8% when compared to those of the mice treated with saline. We further found that the loss of the myelinated fibers length was mainly due to the marked loss of the myelinated nerve fibers with the diameter of 0.4-0.5 µm. These results indicated that the splitting myelin sheaths, demyelination and the loss of myelinated fibers with small diameter might provide one of the structural bases for impaired white matter integrity of CC in the mouse model of SZ. These results might also provide a baseline for further studies searching for the treatment of SZ through targeting white matter.

Clinical and experimental study of Castleman disease in children.

BACKGROUND: Castleman disease (CD) is a rare lymphoproliferative disease that is often underdiagnosed or misdiagnosed, especially in children. For this reason, we describe the clinical manifestations, diagnosis and treatment of CD in 11 children. PROCEDURE: A retrospective study was performed to analyze the clinical features of 11 children with CD in a single institution from January 2001 to December 2012. All had computed tomography (CT) and lymph node resection for pathology diagnosis. RESULTS: The average age of patients was 9.67 ± 4.26 years (range 1.3-15.5 years) including eight males (72.73%) and three females (27.27%). All but two (18.18%) had multicentric Castleman disease (MCD). Human immunodeficiency virus (HIV) or human herpes virus 8 (HHV8) infected cells were not detected in all patients. All patients were misdiagnosed in outside hospitals without tissue examination. Only in one case, the preoperative CT scan suggested CD. After treatment, 10 out of 11 children with CD in our study were disease free in the follow-up period ranging from 12 to 136 months (average 65.1 ± 10.21 months). CONCLUSION: CD in children is rare, and is frequently misdiagnosed clinically. Our study shows that surgical resection is very effective in the treatment of unicentric Castleman disease (UCD). The rare UCD patient and all MCD patients treated with the modified NHLBFM-90 protocol had good prognosis.

Rectification inversion in oxygen substituted graphyne-graphene-based heterojunctions.

Current rectification is found in oxygen-substituted zigzag graphyne nanoribbon/hydrogen-terminated zigzag graphene nanoribbon heterostructure junctions, from the application of nonequilibrium Green's function formalism combined with density functional theory. This behavior could be tuned by varying the number and location of oxygen atoms in the zigzag graphyne nanoribbon parts, and the rectification direction could be reversed due to the parity limitation tunneling effect. Moreover, an obvious negative differential resistance behavior is found and may be explained by two different mechanisms.

White matter injuries induced by MK-801 in a mouse model of schizophrenia based on NMDA antagonism.

The etiology of schizophrenia (SZ) is complex and largely unknown. Neuroimaging and postmortem studies have suggested white matter disturbances in SZ. In the present study, we tested the white matter deficits hypothesis of SZ using a mouse model of SZ induced by NMDA receptor antagonist MK-801. We found that mice with repeated chronic MK-801 administration showed increased locomotor activity in the open field test, less exploration of a novel environment in the hole-board test, and increased anxiety in the elevated plus maze but no impairments were observed in coordination or motor function on accelerating rota-rod. The total white matter volume and corpus callosum volume in mice treated with MK-801 were significantly decreased compared to control mice treated with saline. Myelin basic protein and 2', 3'-cyclic nucleotide 3'-phosphodiesterase were also significantly decreased in the mouse model of SZ. Furthermore, we observed degenerative changes of myelin sheaths in the mouse model of SZ. These results provide further evidence of white matter deficits in SZ and indicate that the animal model of SZ induced by MK-801 is a useful model to investigate mechanisms underlying white matter abnormalities in SZ.

First experience of high-intensity focused ultrasound combined with transcatheter arterial embolization as local control for hepatoblastoma.

UNLABELLED: The purpose of this study was to assess the effectiveness of high-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) in treating pediatric hepatoblastoma. Twelve patients with initially unresectable hepatoblastoma were enrolled in the study. All patients received chemotherapy, TACE, and HIFU ablation. Follow-up materials were obtained in all patients. The tumor response, survival rate, and complications were analyzed. Complete ablation was achieved in 10 patients (83.3%), and the alpha-fetoprotein level was also decreased to normal in these patients. The mean follow-up time was 13.3 ± 1.8 months (range, 2-25 months). At the end of follow-up, two patients died from tumor progression, the other 10 patients were alive. One patient was found to have lung metastasis after HIFU and had an operation to remove the lesion. The median survival time was 14 months, and the 1- and 2-year survival rates were 91.7% and 83.3%, respectively. Complications included fever, transient impairment of hepatic function, and mild malformation of ribs. CONCLUSION: HIFU combined with TACE is a safe and promising method with a low rate of severe complications. As a noninvasive approach, it may provide a novel local therapy for patients with unresectable hepatoblastoma.

Successful management of chylous ascites with total parenteral nutrition and octreotide in children / Éxito de la gestión de la ascitis con nutrición parenteral total y octreótida en niños

Purpose: To evaluate the effects of total parenteral nutrition and octreotide on pediatric patients with chylous ascites post-operative. Methods: Four patients were diagnosed with chylous ascites from Nov 2009 to Nov 2012. Total parenteral nutrition and octreotide was administered to 2 patients, while the other two only received fasting and total parenteral nutrition. All patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily. Results: Two patients who received somatostatin therapy completely recovered within 7d without any recurrence while on a normal diet. The other two patients who only received fasting and total parenteral nutrition was cured 24-30d after therapy. Conclusion: Total parenteral nutrition along with octreotide can relieve the symptoms and close the chyle leakage in patients with chylous ascites rapidly. It seems to be an effective therapy available for the treatment of chylous ascites (AU)

Propósito: Evaluar los efectos de la nutrición parenteral total y el octreótido en pacientes pediátricos con ascitis quilosa posoperatoria. Métodos: Se diagnosticó a cuatro pacientes de ascitis quilosa entre noviembre de 2009 y noviembre de 2012. Se administraron nutrición parenteral total y octreótido a dos 2 parientes, mientras que los otros dos sólo recibieron ayuno y nutrición parenteral total. Todos los pacientes tuvieron drenaje peritoneal persistente, observándose la cantidad y calidad del líquido de drenaje a diario. Resultados: Los dos pacientes que recibieron el tratamiento con somatostatina se recuperaron por completo en 7 días, sin recurrencia cuando instauraron una dieta normal. Los otros dos pacientes que sólo realizaron ayuno y nutrición parenteral total se curaron después de 24-30 días de tratamiento. Conclusión: La nutrición parenteral total junto con el octreótido pueden aliviar rápidamente los síntomas y cerrar la fuga de quilo en pacientes con ascitis quilosa. Parece ser un tratamiento eficaz para la ascitis quilosa (AU)

Successful management of chylous ascites with total parenteral nutrition and octreotide in children.

PURPOSE: To evaluate the effects of total parenteral nutrition and octreotide on pediatric patients with chylous ascites post-operative. METHODS: Four patients were diagnosed with chylous ascites from Nov 2009 to Nov 2012. Total parenteral nutrition and octreotide was administered to 2 patients, while the other two only received fasting and total parenteral nutrition. All patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily. RESULTS: Two patients who received somatostatin therapy completely recovered within 7d without any recurrence while on a normal diet. The other two patients who only received fasting and total parenteral nutrition was cured 24-30 d after therapy. CONCLUSION: Total parenteral nutrition along with octreotide can relieve the symptoms and close the chyle leakage in patients with chylous ascites rapidly. It seems to be an effective therapy available for the treatment of chylous ascites.

Purpose: To evaluate the effects of total parenteral nutrition and octreotide on pediatric patients with chylous ascites post-operative. Methods: Four patients were diagnosed with chylous ascites from Nov 2009 to Nov 2012. Total parenteral nutrition and octreotide was administered to 2 patients, while the other two only received fasting and total parenteral nutrition. All patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily. Results: Two patients who received somatostatin therapy completely recovered within 7d without any recurrence while on a normal diet. The other two patients who only received fasting and total parenteral nutrition was cured 24-30d after therapy. Conclusion: Total parenteral nutrition along with octreotide can relieve the symptoms and close the chyle leakage in patients with chylous ascites rapidly. It seems to be an effective therapy available for the treatment of chylous ascites.

Ovarian germ cell tumors in children: a 20-year retrospective study in a single institution.

PURPOSE: Ovarian germ cell tumors are rare in childhood. The goal of the study is to provide information that may help guide the evaluation and surgical management of future children with ovarian tumors. METHODS: A retrospective review of patients with ovarian germ cell tumors between January 1990 and January 2010 was performed. RESULTS: 137 patients were included with a median age of 9.5 years. Teratomas were found most frequently (mature: 78, immature: 6), followed by yolk sac tumors (n = 51), dysgerminoma (n = 1) and embryonal carcinoma (n = 1). Abdominal pain (81.8%) and abdominal distension (58.4%) were the most common symptoms. Twenty-six infants were found prenatally. Twenty-one patients presented torsion of the ovary. Alpha-feto-protein levels were elevated in all pure yolk sac tumors, two immature teratomas and one embryonal carcinoma. Most patients (84) were Stage I, 16 were Stage II, 23 Stage III, and four Stage IV. All patients with mature and immature teratomas (grade 1) underwent surgery alone. Surgery + chemotherapy were conducted in 55 other patients. The surgical procedures consisted of salpingo-oophorectomy (n = 68), oophorectomy (n = 21) and ovarian-sparing tumorectomy (n = 48). Sixteen patients gave up the treatment and died. Excluding this subset, 5-year relapse-free survival and overall survival was 93.4% and 98.3%, respectively. No recurrences were observed in any patients. CONCLUSION: Ovarian germ cell tumors have an excellent prognosis. With accurate staging, complete resection, and adjuvant chemotherapy, patients should be expected to have excellent survival rates. Preservation of ovarian tissue should be considered whenever safe and feasible, however, this needs to be confirmed by studies on larger numbers of patients.