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Evaluation and management of the child with hypothyroidism

World Journal of Pediatrics 2019年第2期15卷 124-134页

作者： alexander K.c.leung alexander a.c.leung Department of Pediatrics The University of Calgaryand The Alberta Children's Hospital#200233-16th Avenue NWCalgaryAB T2M 0H5Canada Department of Medicine The University of CalgaryCalgaryABCanada

Background Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout *** recognition and treatment of hypothyroidism is,therefore,of utmost importance to optimize physical and neurodevelopmental *** sources A PubMed search was completed in clinical Queries using the key terms 'hypothyroidism'.Results Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism).Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism,*** than 95% of infants with congenital hypothyroidism have few,if any,clinical manifestations of *** screening programs allow early detection of congenital *** developed countries,Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and ***,iodine deficiency associated with goiter is the most common cause of *** hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary *** of the clinical features would allow prompt diagnosis and institution of *** To optimize neurocognitive outcome in infants with congenital hypothyroidism,treatment with levothyroxine should be started as soon as possible,preferably within the first 2 weeks of *** with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive *** target is to keep serum TSH cific reference range,with elimination of all symptoms and signs of hypothyroidism.

关键词： Dysgenesis Dyshormonogenesis Hashimoto thyroiditis Hypothyroidism Iodine deficiency Levothyroxine Mental retardation Stunted growth

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Microglia:a promising therapeutic target in spinal cord injury

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Neural Regeneration Research 2025年第2期20卷 454-463页

作者： Xiaowei Zha Guoli Zheng Thomas Skutella Karl Kiening Andreas Unterberg alexander Younsi Department of Neurosurgery Heidelberg University HospitalHeidelbergGermany Department of Neuroanatomy Institute for Anatomy and Cell BiologyHeidelberg UniversityHeidelbergGermany

Microglia are present throughout the central nervous system and are vital in neural repair,nutrition,phagocytosis,immunological regulation,and maintaining neuronal *** a healthy spinal cord,microglia are accountable for immune surveillance,however,when a spinal cord injury occurs,the microenvironment drastically changes,leading to glial scars and failed axonal *** this context,microglia vary their gene and protein expression during activation,and proliferation in reaction to the injury,influencing injury responses both favorably and unfavorably.A dynamic and multifaceted injury response is mediated by microglia,which interact directly with neurons,astrocytes,oligodendrocytes,and neural stem/progenitor *** a clear understanding of their essential nature and origin,the mechanisms of action and new functions of microglia in spinal cord injury require extensive *** review summarizes current studies on microglial genesis,physiological function,and pathological state,highlights their crucial roles in spinal cord injury,and proposes microglia as a therapeutic target.

关键词： astrocytes cytokines functional recovery immune regulation M1/M2 activation macrophages microglia neuroinflammation spinal cord injury therapy

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childhood Langerhans cell histiocytosis:a disease with many faces

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World Journal of Pediatrics 2019年第6期15卷 536-545页

作者： alexander K.c.leung Joseph M.Lam Kin Fon Leong Department of Pediatrics The University of Calgaryand The Alberta Children's Hospital#20023316th Avenue NWCalgaryAB T2M 0H5Canada Department of Pediatrics University of British ColumbiaVancouverBCCanada Department of Dermatology and Skin Sciences University of British ColumbiaVancouverBCCanada Pediatric Institute Kuala Lumpur General HospitalKuala LumpurMalaysia

Background Langerhans cell histiocytosis(LcH)is a group of diseases characterized by the proliferation and accumulation of Langerhans *** presentations of LcH vary *** sources A PubMed search was conducted using clinical Queries with the key term "Langerhans cell histiocytosis".The search strategy included meta-analyses,randomized controlled trials,clinical trials,observational studies,and *** paper is based on,but not limited to,the search *** Generally,patients with LcH can be divided into two groups based on the extent of involvement at diagnosis,namely,single-system LcH and multisystem *** involvement may be unifocal or *** with isolated bone lesions typically present between 5 and 15 years of age,whereas those with multisystem LcH tend to present before 5 years of *** clinical spectrum is broad,ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem *** manifestations include,among others,"punched out" lytic bone lesion,seborrheic dermatitis-like erup-tion,erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches,and eczematous lesions,diabetes insipidus,hepatosplenomegaly,cytopenias,lymphadenopathy,and an acute fulminant disseminated multisystem condition presenting with fever,skin rash,anemia,thrombocytopenia,lymphadenopathy,and *** diagnosis is clinicopathologic,based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional *** cD1a,S100,and/or cD207(Langerin)immunohistochemical staining of lesional cells is required for a definitive *** waiting is recommended for patients with skin-only *** with symptomatic or refractory skin-only LcH may be treated with topical tacrolimus/corticosteroids,topical nitrogen mustard,oral methotrexate,or oral *** current recommended first-line therapy for patients with multisystem LcH i

关键词： cytopenia Diabetes insipidus Eczematous lesions Hepatosplenomegaly Lymphadenopathy Seborrheic dermatitis-like eruption

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Staphylococcal-scalded skin syndrome:evaluation,diagnosis,and management

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World Journal of Pediatrics 2018年第2期14卷 116-120页

作者： alexander K.c.leung Benjamin Barankin Kin Fon Leong Department of Pediatrics The Alberta Children's HospitalThe University of CalgaryCalgary#200233-16th Avenue NWCalgaryAB T2M 0H5Canada Toronto Dermatology centre TorontoONCanada The Pediatric Institute Kuala Lumpur General HospitalKuala LumpurMalaysia

Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric *** diagnosis and treatment is imperative to reduce the morbidity and mortality of this *** purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of *** sources A PubMed search was completed in clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus *** of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla *** diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal *** empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide *** or cefuroxime may be used should the patient have penicillin *** the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant *** is high,vancomycin should be *** A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.

关键词： Blisters Desquamation Erythroderma Exfoliative toxins Staphylococcus aureus

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Erythema nodosum

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World Journal of Pediatrics 2018年第6期14卷 548-554页

作者： alexander K.c.leung Kin Fon Leong Joseph M.Lam Department of Pediatrics The Alberta Children's HospitalThe University of Calgary#200233-16th Avenue NWCalgaryAB T2M 0H5Canada Pediatric Institute Kuala Lumpur General HospitalKuala LumpurMalaysia Department of Pediatrics and Department of Dermatology and Skin Sciences University of British ColumbiaVancouverBCCanada

Background Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum. Data sources A PubMed search was completed in clinical Queries using the key terms 'erythema nodosum'. Results clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflamma-tory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or c-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of ery-thema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management. conclusions As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.

关键词： Drug-induced Group A β-hemolytic streptococcal infection Sarcoidosis Subcutaneous pretibial nodules Tuberculosis Yersinia infection

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Gianotti-crosti syndrome(papular acrodermatitis of childhood)in the era of a viral recrudescence and vaccine opposition

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World Journal of Pediatrics 2019年第6期15卷 521-527页

作者： alexander K.c.leung consolato Maria Sergi Joseph M.Lam Kin Fon Leong Department of Pediatrics The University of CalgaryCalgaryCanada The Alberta children's Hospital #200233-16th Avenue NWCalgaryAB T2M OH5Canada The University of Alberta EdmontonABCanada Departments of Pediatrics Dermatology and Skin SciencesUniversity of British ColumbiaVancouverBCCanada Pediatric Institute Kuala Lumpur General HospitalKuala LumpurMalaysia

Background Gianotti-crosti syndrome is characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical *** sources A PubMed search was conducted using clinical Queries with the key terms"Gianotti-crosti syndrome"OR"papular acrodermatitis".The search strategy included meta-analyses,randomized controlled trials,clinical trials,observa-tional studies,and *** paper is based on,but not limited to,the search *** The eruption of Gianotti-crosti syndrome is found predominantly on the cheeks,extensor surfaces of the extremities,and *** is a sparing of antecubital and popliteal fossae as well as palms,soles,and mucosal *** often asymptomatic,the lesions may be mildly to moderately ***-crosti syndrome is most common in children between 1 and 6 years of *** Epstein-Barr virus and the hepatitis B virus are the most common pathogens associated with Gianotti-crosti *** treatment for Gianotti-crosti syndrome is necessary because it is *** an era of vaccine hesitancy and refusal,Gianotti-crosti syndrome may be important to mention to parents,because it can occur and trigger *** Gianotti-crosti syndrome is mainly a disease of early childhood,characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical *** the advent of more universal vaccination against hepatitis B virus,Epstein-Barr virus has become the most common etiologic agent of Gianotti-crosti *** cases of post-vaccination Gianotti-crosti syndrome have been ***,the emphasis should be placed on its self-limiting attribution.

关键词： Epstein-Barr virus Hepatitis B virus Papular acrodermatitis Papular symmetrical eruption

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Incidental seminal vesicle amyloidosis observed in diagnostic prostate biopsies--are routine investigations for systemic amyloidosis warranted？

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Asian Journal of Andrology 2013年第1期15卷 149-151页

作者： Zichu Yang alexander Laird Ashley Monaghan Morag Seywright Imran Ahmad Hing Y leung Institute of cardiovascular and Medical Sciences College of Medical Veterinary and Life Sciences University of Glasgow Glasgow Scotland G12 8QQ UK Department of Urology Gartnavel General Hospital NHS Great Glasgow and Clyde Glasgow Scotland G12 OYN UK pathology NHSGGc Southern General Hospital Glasgow Scotland G51 4TF UK The Beatson Institute for cancer Research Glasgow Scotland G61 1BD UK

Seminal vesicle （SV） amyloidosis is a well-documented histological entity, but it is observed infrequently. Its incidence is on the rise, which is probably related to the increasing use of prostate biopsies to investigate patients with elevated serum prostate-specific antigen levels. Here, we report seven cases of incidental SV amyloidosis over a 3-year period and consider their relationship to the previously suggested aetiological factors. Based on our series, we conclude that incidental localized SV amyloidosis observed in diagnostic prostate biopsies does not warrant formal investigations for systemic amyloidosis.

关键词： accessory sex organs male prostate biopsies prostate cancer prostate diseases prostatitis seminal vesicle amyloidosis

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Impact of IPMOE on nursing tasks in the medical ward: A time-motion study

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International Journal of Nursing Sciences 2018年第1期5卷 50-56页

作者： Ming leung Kenny Kin chung chan Wing leung Wong alexander chun Bon Law Princess Margaret Hospital Hong KongChina Tuen Mun Hospital Hong KongChina Hong Kong Baptist University Hong KongChina

Introduction:The In-patient Medication Order Entry System (IPMOE) was first implemented in the medical ward of Princess Margaret Hospital,Hong *** was a local developed close-loop system including prescription,dispensing and administration *** on its impact on nursing tasks would be important for practice improvement and subsequent system ***:The study was conducted to quantify the nursing times across medication-associated tasks for paper-based MAR and computer-based IPMOE,including change in the tasks and time patterns before and after IPMOE ***:This was a prospective observation study in medical wards before (Jan 2014-Jun 2014) and after (Mar 2015-Jun 2015) the implementation of *** conducted 8-hr observation studies of individual nurses with a customized application to time various pre-categorized nursing *** inferences and interrupted time series analysis was performed to identify the change in the intercept and trends over time after ***:The average number of medication-related tasks was significantly reduced from 61.07 to 29.81,a reduction of 31.26 episodes per duty (P cI 22.9-39.63).The time for the medication-related tasks was reduced from 32 min (SD =21.57) to 26.57 min (SD =11.35) and the medication administration time increased from 37.93 min (SD-14.78) to 44.37 min (SD 19.45),but there was no overall significant difference in the time spent on each duty (P =0.315) between the two *** improving trend in the delayed effect was observed (P =0.03),which indicated a run-in period for new application was needed in clinical ***:Our study had shown the time motion observation could be applied to measure the impact of the IPMOE in a busy clinical *** classification of activities,validation,objective measurement and longitudinal evaluation,the method could be applied in various systems as well as different clinical settings in

关键词： In-patient medication order entry system Medication systems Nursing Time and motion studies

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Laboratory rearing of solitary bees and wasps

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Insect Science 2016年第6期23卷 918-923页

作者： Mira c. Becker alexander Keller Department of Animal Ecology and Tropical Biology Biocenter University of Wurzburg Wurzburg Germany

Ecological experiments often require standardized methods that exclude natural variation and allow manipulation of a single parameter. It has been shown that domesticated honey bee larvae are raisable in a controlled environment. Here we demonstrate that this approach is also transferable to wild solitary bees and wasps without inducing negative effects on their development. Wells may also be supplemented with the antibiotic substance oxytetracycline to control the presence of bacteria. The method thus provides a useful tool to investigate offspring recruitment and larval development in solitary bees and wasps, plus their responses to manipulation of factors as for example diets, toxins and microbiota.

关键词： diet manipulation ecotoxicology larval ontogeny Osmia bicornis oxytetracycline pathogens

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Hypospadias： an update

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Asian Journal of Andrology 2007年第1期9卷 16-22页

作者： alexander K. c. leung William L. M. Robson Department of Pediatrics The University of Calgary Calgary Alberta T2M 0H5 Canada The Alberta children＇s Hospital Calgary Alberta T2M 0H5 Canada The childrens＇ clinic Calgary Alberta T2M 0H5 Canada

Hypospadias is the most common congenital anomaly of the penis. The problem usually develops sporadically and without an obvious underlying cause. The ectopically positioned urethral meatus lies proximal to the normal site and on the ventral aspect of the penis, and in severe cases opens onto the scrotum or perineum. The foreskin on the ventral surface is deficient, while that on the dorsal surface is abundant, giving the appearance of a dorsal hood. chordee is more common in severe cases. cryptorchidism and inguinal hernia are the most common associated anomalies. The frequency of associated anomalies increases with the severity of hypospadias. For isolated anterior or middle hypospadias, laboratory studies are not usually necessary. Screening for urinary tract anomalies should be considered in patients with posterior hypospadias and in those with an anomaly of at least one additional organ system. The ideal age for surgical repair in a healthy child is between 6 and 12 months of age. Most cases can be repaired in a single operation and on an outpatient basis. Even patients with a less than perfect surgical result are usually able to enjoy a satisfactory sexual life.

关键词： hypospadias sporadic cryptorchidism inguinal hernia renal anomaly repair

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