Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.

Efficacy and Safety of Teriflunomide in Chinese Patients with Relapsing Forms of Multiple Sclerosis: A Subgroup Analysis of the Phase 3 TOWER Study

Background:Disease-modifying therapy is the standard treatment for patients with multiple sclerosis (MS)in remission.The primary objective of the current analysis was to assess the efficacy and safety of two teriflunomide doses (7mg and 14mg)in the subgroup of Chinese patients with relapsing MS included in the TOWER study. Methods:TOWER was a multicenter,multinational,randomized, double-blind,parallel-group (three groups),placebo-controlled study.This subgroup analysis includes 148 Chinese patients randomized to receive either teriflunomide 7mg (n =51), teriflunomide 14mg (n=43),or placebo (n=54). Results:Of the 148patients in the intent-to-treat population, adjusted annualized-relapse rates were 0.63(95% confidence interval [CI]:0.44,0.92)in the placebo group,0.48(95%CI:0.33, 0.70)in the teriflunomide 7mg group,and 0.18(95%CI:0.09,0.36)in the terifltmomide 14mg group;this corresponded to a significant relative risk reduction in the teriflunomide 14mg group versus placebo (-71.2%,P =0.0012).Terifiunomide 14mg also tended to reduce 12-week confirmed disability worsening by 68.1% compared with placebo (hazard ratio:0.319,P =0.1194).There were no differences across all treatment groups in the proportion of patients with treatment-emergent adverse events (TEAEs;72.2% in the placebo group,74.5%in the teriflunomide 7mg group,and 69.8% in the teriflunomide 14mg group);corresponding proportions for serious adverse events were 11.1%,3.9%,and 11.6%,respectively.The most frequently reported TEAEs with teriflunomide versus placebo were neutropenia,increased alanine aminotransferase,and hair thinning. Conclusions:Teriflunomide was as effective and safe in the Chinese subpopulation as it was in the overall population of patients in the TOWER trial.Teriflunomide has the potential to meet unmet medical needs for MS patients in China.

Combating echinococcosis in China:strengthening the research and development

Echinococcosis is a neglected zoonotic disease,causing great morbidity and mortality due to the wide distribution of its endemic areas.China holds a high percentage in the global burden of both cystic and alveolar echinococcosis.A national survey conducted between 2012 and 2016 showed that an estimated 50 million people are at risk of contracting the disease in western China,of whom about 0.17 million are cases with echinococcosis.Despite this,research and development on echinococcosis in China is greatly inadequate compared to that in other countries.In this paper,we argue that there is a need for more research and work to be conducted in China on echinococcosis,including researching techniques in regards to diagnosis,treatment,and vaccination,and developing products through technical transformation and piloting strategies to control and even elimination.However,great opportunities exist for China to strengthen the research and development on this disease through initiatives such as Health China 2030,the Belt and Road Initiative,the China-Africa cooperation,as well as through further cooperation between China and the World Health Organization.All of these can bring us closer to controlling echinococcosis in China as well as in other countries.One element of crucial importance will be the training and development of professionals,which can be strengthened through international cooperation.

Seasonal pattern of Echinococcus re-infection in owned dogs in Tibetan communities of Sichuan, China and its implications for control

Background:Human cystic echinococcosis(CE)and alveolar echinococcosis(AE)are highly endemic in Tibetan communities of Sichuan Province.Previous research in the region indicated that domestic dog was the major source of human infection,and observations indicated that domestic dog could have more access to intermediate hosts of Echinococcus spp.:both domestic livestock(CE)viscera and small mammals(AE),in early winter and again in spring.We hypothesized that there would therefore be a significant increase in the risk of canine infection with Echinococcus spp.in these two seasons and conducted a reinfection study to investigate this further.Methods:Faecal samples were collected from owned dogs in seven townships in Ganze Tibetan Autonomous Prefecture(Sichuan Province,China),and Echinococcus spp.infection status was determined using copro-antigen ELISA.Dogs were sampled in April(spring),July(early summer),September/October(autumn/early winter)and December(winter)in 2009;and in April(spring)2010.Dogs were treated with praziquantel following each of the five sample collections to eliminate any tapeworms.Information on dog sex,age and body weight was also collected.The t-test,Fisher’s exact test,Poisson regression and logistic regression were used to compare means and prevalences,and to identify factors associated with infection status.Results:The proportion of female dogs was significantly lower than that of male dogs;female dogs had significantly higher(22.78%)baseline copro-ELISA prevalence than males(11.88%).Dog body weight,sex,age,county and previous infection status at any sampling point had no influence on the re-infection prevalence in general.Poisson regression did not found a significant influence on the re-infection prevalence due to different deworming/sampling time spans.Dogs exhibited significantly higher re-infection prevalences in spring and early summer of 2009 and in early winter between September/October and December of 2009,suggesting a higher infection pressure in these seasons comparing with other seasons.Conclusion:Following praziquantel treatment,dog body weight,sex,age,county,deworming time span and previous infection status at any sampling point had no influence on the re-infection prevalence in the region in general.The differences between re-infection prevalences were probably due to the seasonality in Echinoccocus spp.infection pressure in the region.Early winter,spring and early summer should be important seasons for optimal dog deworming intervention in these Tibetan communities.

Epidemiological survey of echinococcosis in Tibet Autonomous Region of China

Background:The echinococcosis is prevalent in 10 provinces/autonomous region in western and northern China.Epidemiological survey of echinococcosis in China in 2012 showed the average prevalence of four counties in Tibet Autonomous Region(TAR)is 4.23%,much higher than the average prevalence in China(0.24%).It is important to understand the transmission risks and the prevalence of echinococcosis in human and animals in TAR.Methods:A stratified and proportionate sampling method was used to select samples in TAR.The selected residents were examined by B-ultrasonography diagnostic,and the faeces of dogs were tested for the canine coproantigen against Echinococcus spp.using enzyme-linked immunosorbent assay.The internal organs of slaughtered domestic animals were examined by visual examination and palpation.The awareness of the prevention and control of echinococcosis among of residents and students was investigated using questionnaire.All data were inputted using double entry in the Epi Info database,with error correction by double-entry comparison,the statistical analysis of all data was processed using SPSS 21.0,and the map was mapped using ArcGIS 10.1,the data was tested by Chi-square test and Cochran-Armitage trend test.Results:A total of 80384 people,7564 faeces of dogs,and 2103 internal organs of slaughtered domestic animals were examined.The prevalence of echinococcosis in humans in TAR was 1.66%,the positive rate in females(1.92%)was significantly higher than that in males(1.41%),(X2=30.31,P<0.01),the positive rate of echinococcosis was positively associated with age(X2trend=-423.95,P<0.01),and the occupational populations with high positive rates of echinococcosis were herdsmen(3.66%)and monks(3.48%).The average positive rate of Echinococcus coproantigen in TAR was 7.30%.The positive rate of echinococcosis in livestock for the whole region was 11.84%.The average awareness rate of echinococcosis across the region was 33.39%.Conclusions:A high prevalence of echinococcosis is found across the TAR,representing a very serious concern to human health.Efforts should be made to develop an action plan for echinococcosis prevention and control as soon as possible,so as to control the endemic of echinococcosis and reduce the medical burden on the population.

Development of a LiFePO_(4)-based high power lithium secondary battery for HEVs applications

A LiFeP04-type lithium secondary battery cell of 8 Ah capacity with a high energy density and power density was developed for hybrid electric vehicle(HEV)applications by optimizing the key raw materials and process design.The 8 Ah class LiFePO_(4)cell with an energy density of 77.2 Wh·kg^(-1)exhibits a power density of 2818 W·kg^(-1)at 50%SOC(state of charge).The battery shows good cyclic capability with the capacity retention of 81.1%after 1,870 cycles at 5 C charge and 10 C discharge rates.It is demonstrated that the cells have an excellent balance of high-power,high-energy,low temperature,and long-life performance for meeting the requirements of HEV.

Research gaps for three main tropical diseases in the People’s Republic of China

This scoping review analyzes the research gaps of three diseases:schistosomiasis japonica,malaria and echinococcosis.Based on available data in the P.R.China,we highlight the gaps between control capacity and prevalence levels,and between diagnostic/drug development and population need for treatment at different stages of the national control programme.After reviewing the literature from 848 original studies and consultations with experts in the field,the gaps were identified as follows.Firstly,the malaria research gaps include(i)deficiency of active testing in the public community and no appropriate technique to evaluate elimination,(ii)lack of sensitive diagnostic tools for asymptomatic patients,(iii)lack of safe drugs for mass administration.Secondly,gaps in research of schistosomiasis include(i)incongruent policy in the implementation of integrated control strategy for schistosomiasis,(ii)lack of effective tools for Oncomelania sp.snail control,(iii)lack of a more sensitive and cheaper diagnostic test for large population samples,(iv)lack of new drugs in addition to praziquantel.Thirdly,gaps in research of echinococcosis include(i)low capacity in field epidemiology studies,(ii)lack of sanitation improvement studies in epidemic areas,(iii)lack of a sensitivity test for early diagnosis,(iv)lack of more effective drugs for short-term treatment.We believe these three diseases can eventually be eliminated in China's Mainland if all the research gaps are abridged in a short period of time.

C-reactive Protein-717A〉 G and-286C 〉T〉A Gene Polymorphism and Ischemic Stroke

Background：Inflammation plays a pivotal role in the formation and progression of ischemic stroke.Recently,more and more epidemiological studies have focused on the association between C-reactive protein （CRP）-717A 〉 G and-286C 〉 T 〉 A genetic polymorphisms and ischemic stroke.However,the findings of these researches are not conclusive.Methods：We performed a meta-analysis to determine whether these two polymorphisms are associated with the risk of ischemic stroke.Eligible studies were identified from the database of PubMed,Medline,Embase,Web of Science,CNKI,Weipu,and Wanfang.We calculated odds ratios （ORs） with 95% confidence intervals （CIs） to assess the strength of the association.Results：Four articles were included in our study,including 1926 cases and 2678 controls for-717A 〉 G polymorphism,652 cases and 1103 controls for-286C 〉 T 〉 A polymorphism.The results of meta-analysis showed that single nucleotide polymorphism （SNP）-717A 〉 G was not significantly associated with the risk of ischemic stroke （GG vs.AA,OR =1.12,95% CI =0.83-1.50,P =0.207;GG ＋ GA vs.AA,OR =1.04,95% CI =0.93-1.17,P =0.533;GG vs.GA ＋ AA,OR =1.10,95% CI =0.82-1.47,P =0.220）.Meta-analysis of SNP-286C 〉 T 〉 A also demonstrated no statistical evidence of a significant association with the risk of ischemic stroke （AA vs.CC,OR =0.86,95% CI =0.59-1.25,P =0.348;AA vs.CC,OR =0.92,95% CI =0.80-1.06,P =0.609;AA vs.CC,OR =0.89,95% CI =0.62-1.30,P =0.374）.Conclusions：This meta-analysis demonstrated little evidence to support a role of CRP gene-717A 〉 G,-286C 〉 T 〉 A polymorphisms in ischemic stroke predisposition.However,to draw comprehensive and more reliable conclusions,further larger studies are needed to validate the association between CRP gene polymorphisms and ischemic stroke in various ethnic groups.

Explicit Solution for Constrained Optimal Execution Problem with General Correlated Market Depth

This work studies the constrained optimal execution problem with a random market depth in the limit order market.Motivated from the real trading activities,our execution model considers the execution bounds and allows the random market depth to be statistically correlated in different periods.Usually,it is difficult to achieve the analytical solution for this class of constrained dynamic decision problem.Thanks to the special structure of this model,by applying the proposed state separation theorem and dynamic programming,we successfully obtain the analytical execution policy.The revealed policy is of feedback nature.Examples are provided to illustrate our solution methods.Simulation results demonstrate the advantages of our model comparing with the classical execution policy.