An Orthopedic Approach to a Child with a Limp: A Step-by-Step Review Article

This article explains the orthopedic approach to limping in children. This is a review article including a selected collection of new articles extracted from PubMed and Google Scholar searched for clinical points and beneficial approaches to limping children. In this paper, limping is divided into two categories, painful and painless. After stating the important points in the patient’s medical history and explaining specific examinations in this area, different gait types in children are explained and the best evaluation method for them is presented. Then, paraclinical examinations and imaging are described in a practical evaluation, high-risk etiologies of limping such as infections, tumors, and fractures are explained in detail and red flags are considered at each step. The algorithms and the list of differential diagnoses for each age group are included, which can provide physicians with a more comprehensive approach to limping in children.

现代免疫学是打开中医药生物机制的钥匙

中医以整体观来认识人的健康与疾病防治,在中国的应用已有数千年历史,传向国际亦有百余年。但是中医与现代医学在疾病理论机理上有很多差别。在现代医学中,免疫学是最复杂的系统之一,是针对病原体的整体防御系统,通过系统平衡调节参与疾病的发生与进展。特别值得一提的是,中医与免疫学在整体观、防御机制、平衡调节,昼夜时辰等方面有着共通之处。本综述重点关注中医和免疫学之间的相同与不同,用现代免疫学的数据阐明传统中医理论的生物学机理。我们相信不断进步的多组学技术,可以深入诠释中医理论机理,用现代免疫学数据为中医的治疗原理和应用疗效提供更多的生物学证据。

HBsAg+&HBV DNA-的HBV感染的血清学和分子生物学特性

目的探索血液筛查结果为HBsAg+&HBV DNA NR的HBV感染的血清学和分子生物学特性。方法通过重复核酸检测、PEG沉降病毒富集联合in-house的巢式PCR和实时荧光定量PCR,对HBsAg+&HBV DNA NR标本进行HBV DNA的确认、抗-HBc和HBsAg定量检测,并将HBV序列与对照组HBV慢性感染和隐匿性感染序列进行比对分析。结果2011年1月~2020年12月,共检测标本792195份,筛选出HBsAg+&HBV DNA-标本53份(1∶14947)。获得S序列3份、Pre Core/Core序列4份,确认含有HBV DNA的标本有5份。Core区域发现独特氨基酸替换(P130T、P135Q/S、R151Q、G153S、S155F),可能对病毒包装、复制产生影响。结论血液筛查结果为HBsAg+&HBV DNA NR的血液存在极低水平的HBV DNA;低水平HBV DNA可能与Pre Core/Core区域的某些突变影响病毒复制有关。选择灵敏度更好的HBsAg和HBV DNA检测试剂能够进一步降低HBV经血传播的潜在风险。

2011年~2020年大连市无偿献血人群HIV-1分子流行病学分析

目的探究2011~2020年大连地区无偿献血人群的HIV-1基因型分布和变化趋势,为临床用血安全、艾滋病防治提供基础数据。方法提取大连市2011~2020年确认HIV感染的无偿献血者标本HIV RNA,并对其pol片段进行扩增、测序,分析标本HIV-1基因型和系统进化关系。结果共完成174份HIV感染标本的基因型分析。大连无偿献血人群HIV-1的流行基因型包括CRF01_AE(69.5%)、CRF07_BC(17.2%)、B(5.2%)、CRF02_AG(2.9%)、C(1.1%)、CRF55_01B(1.1%)、CRF08_BC(0.6%)、CRF59_01B(0.6%)、CRF79_0107(0.6%),以及2例未确定基因型(1.1%)。各基因型分布与全国数据有显著区别;在此10年间,CRF01_AE占比整体呈现波动下降趋势,而CRF07_BC占比明显上升。CRF02_AG感染人群与本地主要基因型相比,女性感染者更多(占比分别为40.0%、2.4%),年龄偏大(中位数分别为35岁、26岁),并且教育水平更低(主要为初中及以下学历)。96.7%的本地CRF01_AE型标本,汇聚于东北地区MSM人群流行的传播簇。结论大连地区无偿献血人群HIV-1型有其独特的分子流行特征,CRF01_AE和CRF07_BC此消彼长的趋势滞后于全国总体数据。对重点人群的征询服务和血液安全宣传、教育亟待加强。

Sorafenib Acts through VEGFR-2 Inhibition in a Metastatic Clear-Cell Sarcoma of the Kidney

We report here the case of a young patient with metastatic clear-cell sarcoma of the kidney resistant to standard chemotherapy, and with complete response under sorafenib treatment. The remarkable response of her tumor to sorafenib led us to study sorafenib molecular targets in the metastatic tissue. Background: Biomarkers predicting response to anti-angiogenic tyrosine kinase inhibitors remain to be identified. Methods and Findings: In this paper, we studied the molecular targets of sorafenib in the lung metastasis of a kidney clear-cell sarcoma. In a patient with complete response under sorafenib treatment, we showed high VEGFR2 expression by tumor endothelial cells from the lung metastasis. Conclusion: The original mechanistic results that we obtained using immunostainings and quantitative RT-PCR on laser-microdissected tumor endothelial cells have a direct application in daily clinical practice: metastatic tumors with a large angiogenic component should be tested for VEGFRs expression to consider anti-angiogenic tyrosine kinase inhibitor treatments.

α-突触素基因双倍体化与家族性帕金森病的因果关系

The α synuclein gene (SNCA) has been implicated in autosomal dominant forms of Parkinsons disease. We screened 119 individuals from families with this rar e form of the disease for SNCA duplications by semiquantitative multiplex PCR. T wo patients had duplications, which were confirmed by analysis of intragenic and flanking microsatellite markers. The phenotype in both patients was indistingui shable from idiopathic Parkinsons disease and no atypical features were presen t, by contrast with reports of families with triplication of the same gene. Thes e results indicate that SNCA is more frequently associated with familial Parkins ons disease than previously thought, and that there is a clear dosage effect a ccording to the number of supernumerary copies of this gene.

糖尿病及高血压对冠状动脉血流储备的累积副作用

Background: this study aimed to assess the hypothesis that essential hypertens ion (EH) may increase coronary microcirculation dysfunction in patients with typ e 2 diabetes mellitus(DM). Microvascular dysfunction has been reported in patien ts with DM or EH. Discordant results have been reported on cumulative adverse ef fects of the simultaneous presence of DM and EH on coronary flow velocity reserv e (CFR). Methods: CFR were compared in 13 hypertensive diabetics (group 1), 12 n ormotensive diabetics (group 2), 11 hypertensive non diabetics (group 3) and 29 normotensive non diabetic patients (group 4). CFR was calculated using an intrac oronary Doppler tipped flow wire. Results: CFR was significantly lower in patie nts with both DM and EH (2.2±0.4 in group 1 vs 2.8±0.5, 2.8±0.6 and 2.9±0.7 in groups 2, 3 and 4 respectively, p< 0.01). The presence of hypertension reduce d CFR in diabetic patients with angiographically abnormal but unobstructed coron ary arteries (2.1±0.3 in hypertensive vs 3.1±0.2 in normotensive diabetic pati ents, p< 0.02). No cumulative adverse effect was observed in diabetics with angi ographically normal coronary arteries (2.3±0.6 in hypertensive vs 2.6±0.5 in n ormotensive diabetic patients, NS). Multivariate analysis revealed that combinat ion of DM and EH (p< 0.007) was independently related to CFR. Conclusions: the p resence of hypertension appears to worsen coronary microangiopathy in diabetic p atients with unobstructed coronary artery disease. The cumulative effect of EH a nd DM on CFR impairment has consequences for decision making during coronary ang ioplasty and could identify patients at risk for cardiomyopathy.

A vision for the future of allogeneic hematopoietic stem cell transplantation in the next decade

The whole field of hematological malignancies has experienced a huge breakthrough during the past 40 years.Major methodological progress in cytogenetics(e.g.,fluorescence in situ hybridization,FISH),immunophenotyping(e.g.,multicolor flow cytometers),and molecular biology(with the discovery of numerous tumor molecular markers by polymerase chain reaction and,more recently,next-generation sequencing)has paved the way for the new concept of detecting and monitoring undetectable minimal residual disease(uMRD)and the engineering of multiple new targeted therapies,such as tyrosine kinase inhibitors and various immunotherapies,including monoclonal antibodies combined or not with antitumor agents,bispecific T-cell-engaging(BiTE)antibodies and chimeric antigen receptor T(CAR-T)cells(Supplementary Text 1 online).

新生儿脑保护策略

围产期脑损伤是导致新生儿儿童期死亡和终身残疾的一个首要原因。大脑麻痹与认知功能障碍通常与脑室周围白质损害或皮层下病变有关，前者主要见于孕龄小于32周的早产婴儿，后者多见于足月婴儿。尽管目前新生儿保健水平有所提高，但围产期脑部病变尚无有效的治疗方法。几种干预措施，如给早产儿应用硫酸镁以及给足月新生儿应用低温疗法，是一些已经结束的和正在进行的临床试验的研究焦点。提高对有关围产期脑损伤病理生理机制的理解，有助于识别潜在的需要神经保护干预的靶点，本文就此进行综述。