Assessment of the severity of curly toe

BackgroundCurly/underlapping toe involves flexion, adduction, and varus deformity of the interphalangeal joints. There are no previous reports showing the relationship between physical examination and X-ray findings among patients with curly toe deformity.MethodsWe investigated the clinical findings of 116 consecutive patients associated with 239 underlapping toes. We compared the age and affected toes between patients whose deformities were pointed out at a pediatric medical examination (group 1) and those referred for medical treatment (group 2). The degree of curly toe deformity was graded by a physical examination and X-ray.ResultsThe average age at presentation was 2.7 years. The affected toes were significantly different between groups 1 and 2 (p < .001). The morbidity of each toe differed significantly in group 2 (p < .005) but not in group 1. The correlation between the appearance grading and classification by X-ray was very strong using Spearman's rank correlation coefficient. The severity of curly toe was divided into mild in 104 toes, moderate in 105 toes, and severe in 17 toes. The methods of conservative treatment were observation only in 15 cases, manipulations in 30 cases, taping in 67 cases, and a brace in 9 cases. Surgery was performed in 8% of cases.ConclusionCurly toe deformity of the third or fourth toes tend to be referred for medical treatment because of the abnormality. Our grading system using a physical examination and classification by X-ray was useful for assessing the severity of curly toe.     

Identification of the immunogenic domains in HBsAg preS1 region using overlapping preS1 fragment fusion proteins

AIM: The incorporation of hepatitis B virus(HBV)preS1 region into epitope-based vaccines against HBV has been accepted widely, but the incorporate site and size of preS1 sequence is controversial.Therefore our purpose was to further investigate its immunogenic domains for the epitope-based hepatitis B vaccine design. METHODS: Eight GST fusion proteins containing overlapping preS1 fragments in preS1(21-119) region were expressed in E.coli. Using these purified fusion proteins, the immunogenic domains in preS1 region were identified in detail in mice and humans by Western blot analysis and ELISA. RESULTS: The results in mice showed that the immunogenic domains mainly existed in preS1(21-59) and preS1(95-109). Similarly, these fragments had strong immunogenicity in humans; whereas the other parts except for preS1(60-70) also had some immunogenicity. More importantly, a major immunogenic domain, preS1 (34-59), which has much stronger immunogenicity, was identified. Additionally, the antibodies against some preS1 fragments, especially preS1(34-59), were speculated to be virus-neutralizing. CONCLUSION: Eight GST fusion proteins containing overlapping preS1 fragments were prepared successfully. They were used for the study on the immunogenic domains in preS1(21-119) region. The preS1(34-59) fragments were the major immunogenic domains in the preS1 region, and the antibodies against these fragments were speculated to be virus-neutralizing. Therefore,the incorporation of preS1(34-59) fragments into epitope-based HBV vaccines may be efficient for enhancement of immune response. Additionally, the results also imply that there are more complex immune responses to preS1 region and more abundant immunogenic domains in humans.     

Pediatric presentations of leptospirosis

OBJECTIVE: Leptospirosis in children is an often under diagnosed condition due to the non specificity of the presentations except for the classical Weil's disease. METHODS: Children presenting with symptoms and signs suggestive of Leptospirosis were included in the study. Diagnostic criteria were fever, myalgia, conjunctival suffusion, Jaundice, headache, altered sensorium, seizures, bleeding manifestation and oliguria. Their clinical profile, lab parameters (general and specific), response to treatment and outcome were analysed. RESULT: One hundred and thirty nine cases were diagnosed during a 4-year period. The commonest symptoms were fever 133 (96%), headache and myalgia 34 (24%). Jaundice was present in only 25 (18%) of cases with renal failure in 2 cases. The frequently encountered clinical signs were hepatomegaly in 100 (72%), myalgia in 34 (24%) with icterus in 25 (18%), 12 (9%) of children presented with shock and 10 (7%) had meningitis. CPK estimated was a useful index of myositis. The diagnosis was confirmed by Dark field microscopy and paired or single high serological tests (MAT, ELISA IgM). Overlapping infections such as culture positive Salmonella typhi with leptospirosis (Serology positive) or Dengue Hemorrhagic fever with Leptospirosis presented with complications such as a myocarditis, shock and ARDS. CONCLUSION: Presentation of non-icteric forms of Leptospirosis are often non-specific and may be missed unless there is a high index of suspicion. This study emphasizes the myositis and meningitis forms of leptospirosis. Delayed diagnosis leads to increased mortality and morbidity.     

The effect of overlapping on the primary stability of osteochondral grafts in mosaicplasty

Our goal was to determine the primary stability of overlapping osteochondral grafts used in mosaicplasty by studying the effect of overlapping in an ex vivo model. Osteochondral grafts, 10 mm in diameter, were transplanted from the trochlea of cow femurs to the weight-bearing area of the lateral femoral condyle with 0, 15, or 30% overlap. The grafts were pushed in with a probe at a rate of 2 mm/min, and load (N)-displacement (mm) curves were recorded. In Group I (control, 0% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 572.3 +/- 273.6 and 999.3 +/- 427.6 N, respectively. In Group II (15% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 263.6 +/- 91.7 and 746.6 +/- 88.0 N, respectively. In Group III (30% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 179.4 +/- 31.2 and 657.0 +/- 106.5 N, respectively. The loads that were necessary to produce a 1-mm dent in the grafts were significantly different between Groups I and II and Groups I and III (p < 0.05). These results suggest that stability may be reduced by graft overlapping in mosaicplasty surgery. The results of this ex vivo animal study contribute to a more complete understanding of the primary stability of osteochondral grafts in an overlapping position as well as postoperative protocols.     

肾盂、输尿管重复畸形的影像学分析

目的：探讨肾盂、输尿管重复畸形的形成机制及其影像学检查方法。材料与方法：回顾性分析从2000年3月～2005年6月在我院诊断为肾盂、输尿管重复畸形的19例病人的影像学及临床资料,探讨其相互关系,寻求最适宜的检查方法。结果：B超可全部显示不同程度肾盂或输尿管积水,腹部平片摄影发现输尿管结石8例,静脉肾盂造影延迟摄影显示肾脏上方或下方造影剂显示6例,CT全部显示重复的肾盂、输尿管,并明确其走行及开口情况。结论：CT检查简单、快捷,可明确显示具体的异常情况,提供更多诊断信息。     

肠易激综合征重叠症的研究进展

肠易激综合征(IBS)是一种常见的以反复发作的腹痛或腹部不适伴排便频率或粪便性状改变为特征的功能性肠病,可单独发生,亦可与其他疾病并存。IBS除可与胃肠道疾病如胃食管反流病(GERD)、功能性消化不良(FD)、炎症性肠病(IBD)、显微镜肠炎(MC)、乳糜泻等重叠外,还可与非胃肠道疾病如焦虑症、哮喘等重叠。本文从流行病学和病理生理学角度对IBS重叠症作一综述。