Childhood acute lymphoblastic leukaemia masquerading as primary skeletal problem

Acute lymphobiastic leukaemia (ALL) usually presents with signs of bone marrow failure, Occasionally ALL in children may present with non-specific or misleading clinical features. In a retrospect analysis of 25 consecutive cases of childhood ALL, we identified three children who were initially managed and discharged as acute osteomyelitis, juvenile chronic arthritis and postinfectious arthralgia respectively. They had mild normochromic, normocytic anaemia and two had transient leucopenia. Their platelet counts were normal and none had circulating blasts. The severity of their skeletal symptoms was out of proportion to the clinical and radiological finding. They failed to respond to the initial management and diagnosis was delayed for an average of 42 days and eventually confirmed on the marrow aspirate. Complete remission was attained in all cases with standard chemotherapy and had been maintained for an average of 29 months. ALL should be considered as a differential diagnosis in children complaining of multiple or persistent joint pains, especially in the presence of atypical clinical features or poor response to treatment.published_or_final_versio

Unilateral epistaxis after swimming in a stream

A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swum in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.published_or_final_versio

Age as a factor in severe bacterial infection in transfusion-dependent patients with thalassemia major [2] (multiple letters)

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Minimal residual disease-based risk stratification in Chinese childhood acute lymphoblastic leukemia by flow cytometry and plasma DNA quantitative polymerase chain reaction

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Plant Diversity Surpasses Plant Functional Groups and Plant Productivity as Driver of Soil Biota in the Long Term

One of the most significant consequences of contemporary global change is the rapid decline of biodiversity in many ecosystems. Knowledge of the consequences of biodiversity loss in terrestrial ecosystems is largely restricted to single ecosystem functions. Impacts of key plant functional groups on soil biota are considered to be more important than those of plant diversity; however, current knowledge mainly relies on short-term experiments.We studied changes in the impacts of plant diversity and presence of key functional groups on soil biota by investigating the performance of soil microorganisms and soil fauna two, four and six years after the establishment of model grasslands. The results indicate that temporal changes of plant community effects depend on the trophic affiliation of soil animals: plant diversity effects on decomposers only occurred after six years, changed little in herbivores, but occurred in predators after two years. The results suggest that plant diversity, in terms of species and functional group richness, is the most important plant community property affecting soil biota, exceeding the relevance of plant above- and belowground productivity and the presence of key plant functional groups, i.e. grasses and legumes, with the relevance of the latter decreasing in time.Plant diversity effects on biota are not only due to the presence of key plant functional groups or plant productivity highlighting the importance of diverse and high-quality plant derived resources, and supporting the validity of the singular hypothesis for soil biota. Our results demonstrate that in the long term plant diversity essentially drives the performance of soil biota questioning the paradigm that belowground communities are not affected by plant diversity and reinforcing the importance of biodiversity for ecosystem functioning

Combined long-segment angioplasty and stenting of the superficial femoral artery and popliteal-distal bypass for limb salvage

The treatment of multisegment superficial femoral artery and tibial vessels atherosclerotic disease is traditionally a femoro-distal bypass using in situ or reversed autogenous vein. The improved result of balloon angioplasty and stenting of the superficial femoral artery (SFA) has extended its application to treat long segment SFA stenosis. A combined endovascular-open surgery approach of SFA endovascular stenting with a popliteal-distal bypass is an alternative less invasive procedure to achieve optimum distal revascularization for limb salvage.link_to_subscribed_fulltex

Catheter-associated nocardiosis [3]

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