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简介：AbstractIntroduction:Lichen planus pigmentosus inversus (LPPI) is a rare a rare variant of lichen planus characterized by hyperpigmented patches with predominating localization in intertriginous areas. Due to its rarity, only a few LPPI cases are reported. We herein describe two rare cases of LPPI.Case presentation:The two patients were all with a brownish macular lesion on the intertriginous area. A diagnosis of LPPI was made based on their clinical manifestations, dermoscopic features, and histopathologic features, which revealed an interface change, lichenoid infiltration, and pigmentary incontinence.Discussion:LPPI is pruritic or asymptomatic, hyperpigmented macules and patches on the flexural folds. The axillae and flanks were the most commonly affected areas, followed by the groin and genitalia. About half of the female patients had inframammary fold lesions. LPPI shows higher female predominance than Lichen planus pigmentosus. There were fewer cases that lasted more than 3 years compared to LPP.Conclusion:LPPI is a rare variant of lichen planus, with a locational characteristic and female predominance. Therefore, in the case of a pigmented disease occurring in the flexural folds, it should be placed in the differential diagnosis.

简介：摘要：本文基于奈达的功能对等理论对《黑暗之心》的两个中文译本进行对比研究，通过具体译例从词法、句法和语篇三个维度对两个译文进行比较鉴赏。

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简介：AbstractIntroduction:Scarring and non-scarring alopecias have rarely been described to occur together in the same patient. Distinguishing these two different types of alopecia is important as treatment and prognosis can be different.Case presentation:Here, we report the first case of simultaneous alopecia areata (AA) and central centrifugal cicatricial alopecia (CCCA) in a 35-year-old woman. New alopecic patches were noted on her frontal and vertex scalp. Biopsy of the frontal scalp revealed miniaturized hair follicles and dense lymphocytic infiltrate surrounding the hair bulbs, consistent with AA; while biopsy of the vertex scalp revealed decreased hair follicles, perifollicular fibroplasia with eccentric atrophy of the follicular epithelium, and premature desquamation of the inner root sheath at the level of the lower isthmus, consistent with CCCA.Discussion:Proposed mechanisms of these two alopecia types occurring together include loss of immune privilege, genetic predisposition, as well as unknown external factors that trigger an autoimmune lymphocytic response. Most recently, the peptidylarginine deiminase type III gene has been implicated in both diseases. Although treatment options can overlap between the two diseases, treatment response can differ and CCCA tends to have a worse prognosis.Conclusion:Awareness of this concomitant presentation of two alopecic types is important for appropriate treatment and prognostication.

简介：AbstractImportance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns. These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately. There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City, to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014, 2564 one-day-old newborns were screened by a pediatric orthopedic physical examination, in combination with ultrasonography when required, and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns, the following musculoskeletal conditions were identified: congenital muscular torticollis (CMT) (seven cases, 0.27%), hip subluxation (four cases, 0.16%), hip dysplasia (47 cases, 1.83%), congenital talipes equinovarus (CTEV) (two cases, 0.08%), congenital talipes calcaneovalgus (15 cases, 0.58%), polydactyly (nine cases, 0.35%), syndactyly (one case, 0.04%), and spinal hemivertebra (one case, 0.04%). Additionally, there were five (0.19%) neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China. This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.

简介：AbstractPurpose:The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Methods:Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results:Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Conclusion:Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

简介：AbstractUterus didelphys occurs in ~0.4% of females and is found in ~11%-20% of all uterus defects. It is a risk factor for cervical insufficiency, consequently contributing to late miscarriage or preterm birth. Thus far, only two prior cases of uterus didelphys accompanied by cervical insufficiency treated through laparoscopic cervical cerclage have been reported; however, livebirth only occurred in one hemiuterus. Herein, we report a case of uterus didelphys in a patient diagnosed with cervical insufficiency. Following the placement of a modified laparoscopic cervical cerclage, the patient had two successful livebirths through both hemiuteruses, respectively, with longer gestation age (ie, >36 weeks). The aim of this case report was to provide useful information for clinical practitioners to make better decisions on the management of cervical insufficiency in patients with uterus didelphys, and identify obstetric complications that clinicians should pay attention to during pregnancy.

简介：AbstractBackground:Systemic lupus erythematosus (SLE) is a complex autoimmune disease, and the mechanism of SLE is yet to be fully elucidated. The aim of this study was to explore the role of two-pore segment channel 2 (TPCN2) in SLE pathogenesis.Methods:Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expression of TPCN2 in SLE. We performed a loss-of-function assay by lentiviral construct in Jurkat and THP-1 cell. Knockdown of TPCN2 were confirmed at the RNA level by qRT-PCR and protein level by Western blotting. Cell Count Kit-8 and flow cytometry were used to analyze the cell proliferation, apoptosis, and cell cycle of TPCN2-deficient cells. In addition, gene expression profile of TPCN2-deficient cells was analyzed by RNA sequencing (RNA-seq).Results:TPCN2 knockdown with short hairpin RNA (shRNA)-mediated lentiviruses inhibited cell proliferation, and induced apoptosis and cell-cycle arrest of G2/M phase in both Jurkat and THP-1 cells. We analyzed the transcriptome of knockdown- TPCN2-Jurkat cells, and screened the differential genes, which were enriched for the G2/M checkpoint, complement, and interleukin-6-Janus kinase-signal transducer and activator of transcription pathways, as well as changes in levels of forkhead box O, phosphatidylinositol 3-kinase/protein kinase B/mechanistic target of rapamycin, and T cell receptor pathways; moreover, TPCN2 significantly influenced cellular processes and biological regulation.Conclusion:TPCN2 might be a potential protective factor against SLE.

简介：摘要IntroductionDelayed encephalopathy due to carbon monoxide (CO) poisoning can even occur in patients with mild symptoms of acute CO poisoning. Some cases taking conventional hyperbaric oxygen (HBO) therapy or steroid-pulse therapy may be insufficient, and AchEI may be effective.Patient concerns and diagnosesWe report two cases of delayed encephalopathy after acute CO poisoning involving two women aged 69 (Case 1) and 60 years (Case 2) whose cognitive function improved with acetylcholinesterase inhibitor (AchEI) treatment. Delayed encephalopathy occurred 25 and 35 days after acute CO poisoning in Case 1 and Case 2, respectively. Both patients demonstrated cognitive impairment, apathy, and hypokinesia on admission.Interventions and outcomesAlthough hyperbaric oxygen therapy did not yield any significant improvements, cognitive dysfunction improved substantially. This was evidenced by an improved Mini-Mental State Examination score from 9 to 28 points in Case 1 and an improved Hasegawa′s dementia rating scale score from 4 to 25 points in Case 2 after administration of an AchEI. In Case 1, we administered galantamine hydrobromide, which was related with improved white matter lesions initially detected on brain magnetic resonance imaging. However, in Case 2 white matter lesions persisted despite AchEI treatment. AchEI treatment may result in improved cognitive and frontal lobe function by increasing low acetylcholine concentrations in the hippocampus and frontal lobe caused by decreased nicotinic acetylcholine receptor levels in delayed encephalopathy after CO poisoning.ConclusionPhysicians should consider AchEIs for patients demonstrating delayed encephalopathy due to CO poisoning.

简介：AbstractImportance:Effective screening strategies for early-onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates.Objective:To compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks’ gestation between February and July 2019, who were (1) managed according to CG149-NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture-proven sepsis. Based on SRC projections, neonates with '≥1 NICE clinical indicator and ≥1 risk factor’ were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks’ gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02–5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16–8.48) increased the risk of an SRS >3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near-term neonates in level 2 neonatal units.

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简介：摘要：四生课堂理论以生命性、生长性、生活性和生成性为基本特征。基于四生课堂理论的小学英语阅读教学模式能够彰显阅读教学主体的生命性，重视阅读教学目的的生长性，体现阅读教学内容的生活性，显示阅读教学过程的生成性。基于四生课堂理论的小学英语阅读教学设计实践探索是提高小学英语阅读课堂教学水平的积极实践。