BACKGROUNDObstructive sleep apnea affects up to 2.9% of children. This study was to determine demographic and clinical characteristics of a group of children with obstructive sleep apnea syndrome (OSAS) as defined by sleep polysomnography (PSG).

METHODSA prospective study was conducted in a public-funded general hospital in Hong Kong of China. Children confirmed to have OSAS by PSG were followed up between January 1997 and December 1998. Tonsillectomy and adenoidectomy (T&A) was offered to those with moderate to severe OSAS, and medication was offered to those with mild OSAS. All children were followed up regularly in the sleep clinic and sleep PSG was repeated for those with marked relapse in symptoms.

RESULTSEighty-nine children (64 boys and 25 girls, mean age 7 years) were confirmed to have OSAS out of 352 children who underwent PSG during the study period. The most common symptoms of OSAS were snoring (100%) and sweating (81%) during sleep and nasal blockage (61%) and sleepiness (34%) during daytime. Severe OSAS occurred in 15 children. Moderate OSAS occurred in 33 children. Forty-one children had mild OSAS. Forty-nine children underwent T&A, 5 (boys, < 5 years) out of whom were found to have recurrent OSAS within 1 year.

CONCLUSIONA male predominance has been found in a group of Hong Kong children with OSAS. Boys undergoing T&A at an early age (< 5 years) will be more likely to develop repeated OSAS.

Adenoidectomy ; Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Prospective Studies ; Recurrence ; Sleep Apnea, Obstructive ; surgery ; Tonsillectomy

Methods: This study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors. Results: Implant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure. Conclusions The development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

Background: Total knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported. Methods: A prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA. Results: The hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C (p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons (p = 0.05), whereas no significant difference was observed between Group A and B (p = 0.09) or between Group B and C. Conclusion The weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups.Trial registrationThe Joint CUHK-NTEC CREC, CRE-2013.644-T. Registered 1 March 2014.

Background: Total knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported. Methods: A prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA. Results: The hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C (p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons (p = 0.05), whereas no significant difference was observed between Group A and B (p = 0.09) or between Group B and C. Conclusion The weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups.Trial registrationThe Joint CUHK-NTEC CREC, CRE-2013.644-T. Registered 1 March 2014.

Purpose: Radiomic models elaborate geometric and texture features of tumors extracted from imaging to develop predictors for clinical outcomes. Stereotactic body radiation therapy (SBRT) has been increasingly applied in the ablative treatment of thoracic tumors. This study aims to identify predictors of treatment responses in patients affected by early stage non-small cell lung cancer (NSCLC) or pulmonary oligo-metastases treated with SBRT and to develop an accurate machine learning model to predict radiological response to SBRT. Materials and Methods: Computed tomography (CT) images of 85 tumors (stage I–II NSCLC and pulmonary oligo-metastases) from 69 patients treated with SBRT were analyzed. Gross tumor volumes (GTV) were contoured on CT images. Patients that achieved complete response (CR) or partial response (PR) were defined as responders. One hundred ten radiomic features were extracted using PyRadiomics module based on the GTV. The association of features with response to SBRT was evaluated. A model using support vector machine (SVM) was then trained to predict response based solely on the extracted radiomics features. Receiver operating characteristic curves were constructed to evaluate model performance of the identified radiomic predictors. Results: Sixty-nine patients receiving thoracic SBRT from 2008 to 2018 were retrospectively enrolled. Skewness and root mean squared were identified as radiomic predictors of response to SBRT. The SVM machine learning model developed had an accuracy of 74.8%. The area under curves for CR, PR, and non-responder prediction were 0.86 (95% confidence interval [CI], 0.794–0.921), 0.946 (95% CI, 0.873–0.978), and 0.857 (95% CI, 0.789–0.915), respectively. Conclusion Radiomic analysis of pre-treatment CT scan is a promising tool that can predict tumor response to SBRT.

Objectives: To evaluate the association of illicit drug use with bone mineral density (BMD) and hip geometric parameters at the narrow neck. Methods: This is a cross-sectional matched cohort study conducted in the Hong Kong Chinese population. Associations with illicit drug use were estimated using linear regression for BMD (lumbar spine and femoral neck) and hip geometrical parameters (cross-sectional area [CSA], cross-sectional moment of inertia [CSMI], section modulus [SM], average cortical thickness [ACT] and BMD at the narrow neck) after adjusting for age, body mass index (BMI), smoking status, drinking status, physical activity, and history of antipsychotic and antidepressant use. Mean difference and 95% confidence intervals (95% CI) were calculated between 108 illicit drug users and 108 controls using an adjusted linear model and cluster-robust standard errors after matching by age and sex. The false discovery rate was used to correct for multiple testing. Results: Illicit drug users had a significantly lower BMD (g/cm2 ) at the lumbar spine (mean difference: -0.062; 95% CI: -0.108 to − 0.015), and femoral neck (mean difference: -0.058; 95% CI: -0.106 to − 0.010) in the fully adjusted model. Illicit drug users also had a significantly lower CSA (mean difference: -0.238 cm2 ; 95% CI: -0.462 to − 0.013), ACT (mean difference: -0.018 cm; 95% CI: -0.030 to − 0.006) and BMD (mean difference: -0.070 g/ cm2 ; 95% CI: -0.128 to − 0.012) at the narrow neck. Conclusions Illicit drug use is associated with lower BMD and bone strength. Future studies evaluating the risk of illicit drug use with fragility fracture are warranted.

Humans ; Tertiary Care Centers ; Singapore ; Endoscopy, Gastrointestinal ; Intestinal Diseases/diagnostic imaging*

OBJECTIVETo describe the influenza viruses antibody levels and contact patterns of individuals in rural and urban regions of Guangzhou and to understand how contact patterns and other factors would correlate with the levels on the titers of antibody.

METHODS"Google Map" was used to randomly select the study points from the administrative areas in Guangzhou region. Each participant was required to provide 5 ml blood serum sample to be tested against different strains of H1N1 and H3N2 influenza viruses.

RESULTS1) Using "Google map", 50 study points were selected but only 40 study points would meet the inclusion criteria. The cohort of this study consisted 856 households with 2 801 individuals. 1 821 participants (65% of the total number individuals in the cohort) completed the questionnaires. Among the 1 821 participants, 77.3% (1 407/1 821) and 22.7% (414/1 821) of them were from rural and urban areas respectively. There were more male participants in the rural but more female participants in the urban regions. Majority of the participants were from age group 18-59 followed by group 60 with aged 2-17 the least, in both rural and urban areas. 2) 78.1% (1 423/1 821) of the participants provided their serum samples. There appeared a strong correlation between age of the participants and the strength of their antibodies against that strain when a strain first circulated. In particular, seroprevalence was the highest at the age group 2-17. 3) 'Contact' was defined as persons having physical touch or/and conversation within one meter with the participants. Participants reported all having had large number of contacts. The proportion of participants having contacts with ten persons or above was the highest, ranging from 49.8% to 72.6%, particularly in age group 6-17. Compared to weekdays, participants had fewer contact persons on weekends.

CONCLUSIONThere was a strong correlation between the age of participants at the time when the strains first circulated and the seroprevalence against influenza virus strains of H1N1 and H3N2. Also, age of the participants and the frequencies of their contacts to people, was also correlated.

Adolescent ; Adult ; Antibodies, Viral ; blood ; Child ; Child, Preschool ; China ; epidemiology ; Contact Tracing ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; immunology ; Influenza A Virus, H3N2 Subtype ; immunology ; Influenza, Human ; epidemiology ; Male ; Middle Aged ; Seroepidemiologic Studies ; Young Adult

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.

INTRODUCTION: An echocardiographic calcium score (ECS) predicts cardiovascular disease (CVD) in the general population. Its utility in peritoneal dialysis (PD) patients is unknown. METHODS: This cross-sectional study assessed 125 patients on PD. The ECS (range 0-8) was compared between subjects with CVD and those without. RESULTS: Among the subjects, 54 had CVD and 71 did not. Subjects with CVD were older (69 years vs. 56 years, P < 0.001) and had a higher prevalence of diabetes mellitus (DM) (81.5% vs. 45.1%, P < 0.001). They had lower diastolic blood pressure (72 mmHg vs. 81 mmHg, P < 0.001), lower phosphate (1.6 mmol/L vs. 1.9 mmol/L, P = 0.002), albumin (30 g/L vs. 32 g/L, P = 0.001), parathyroid hormone (34.4 pmol/L vs. 55.8 pmol/L, P = 0.002), total cholesterol (4.5 vs. 4.9, P = 0.047), LDL cholesterol (2.4 mmol/L vs. 2.8 mmol/L, P = 0.019) and HDL cholesterol (0.8 mmol/L vs. 1.1 mmol/L, P = 0.002). The ECS was found to be higher in subjects with CVD than in those without (2 vs. 1, P = 0.001). On multivariate analysis, only DM and age were independently associated with CVD. CONCLUSION The ECS was significantly higher in PD patients with CVD than in those without, reflecting a higher vascular calcification burden in the former. It is a potentially useful tool to quantify vascular calcification in PD patients.
Humans ; Cardiovascular Diseases/diagnostic imaging* ; Cross-Sectional Studies ; Calcium ; Peritoneal Dialysis/adverse effects* ; Vascular Calcification/epidemiology* ; Echocardiography