BACKGROUND & AIMS: :Recent evidence suggests that between-individual variation in posture and posture transitions may have important health consequences in adults. The early life development of between-individual variation in posture and posture transitions has not been studied, and the physiological consequences of such variations in childhood are unknown, largely because of the absence of objective methods for measuring posture and posture transitions in young children. This study aimed to examine the objective measurement of posture transitions in pre-school children with the activPAL™ monitor (PAL Technologies, Glasgow). Single-unit activity monitors such as the activPAL™ have a limited output, with data categorized as 'sit/lie', 'stand' or 'walk' and the consequences of this for measurement of posture transitions in young children are unknown. Thirty children (mean age 4.1 years) were videoed for 1 h in nursery while wearing an activPAL™. Video was analysed on a second-by-second basis, with all postures categorized. From direct observation, time spent was sit/lie 46%; stand 35%; walk/run 16%; 3% was spent in heterogeneous non-sit/lie/upright postures (crawl, crouch, and kneel up). Despite these 'non-standard' postures being responsible for a low proportion of time, posture transitions involving them contributed to 34% of total transitions. There was a significant rank-order correlation (r = 0.79, p < 0.0001) between the number of posture transitions measured by activPAL™ and by direct observation. 'Non-standard' postures in young children are probably not a problem if the aim is to measure total time sedentary or active, and the activPAL™ may measure between-individual variation in transitions adequately in young children. However, non-standard postures may present problems for the detailed characterization of posture transitions in early childhood.

背景与目标： : 最近的证据表明，姿势和姿势转换的个体间差异可能对成年人的健康产生重要影响。尚未研究姿势和姿势转换的个体间变化的早期生活发展，并且这种变化在儿童时期的生理后果尚不清楚，这主要是因为缺乏客观的方法来测量幼儿的姿势和姿势转换。这项研究旨在检查activPAL学龄前儿童姿势转变的客观测量™监视器 (格拉斯哥PAL Technologies)。单单元活动监视器，如activPAL™输出有限，数据分类为 “坐/坐”，“站立” 或 “步行”，其对测量幼儿姿势转变的后果尚不清楚。30名儿童 (平均年龄4.1岁) 在托儿所观看了1小时的视频，同时穿着activPAL™。对视频进行了逐秒分析，并对所有姿势进行了分类。从直接观察来看，花费的时间是坐/躺46%; 站立35%; 步行/跑步16%; 3% 是在异质的非坐/躺/直立姿势 (爬行，蹲下和跪下) 中度过的。尽管这些 “非标准” 姿势负责低比例的时间，但涉及它们的姿势转变有助于34% 总转变。activPAL测量的姿势转换次数之间存在显着的顺序相关性 (r = 0.79，p <0.0001)™通过直接观察。如果目的是测量久坐或活动的总时间，那么幼儿的 “非标准” 姿势可能不是问题，而activPAL™可以充分衡量幼儿过渡中的个体间差异。但是，非标准姿势可能会为儿童早期姿势转变的详细表征带来问题。

BACKGROUND & AIMS: :Chondrolipoma is an extremely rare variant of lipoma with cartilaginous metaplasia. The presence of nonlipomatous components can lead to a variety of entities in the differential diagnosis from the radiologic findings. We describe an unusual case of a chondrolipoma occurring in the right ankle of a 9-year-old female. Physical examination showed a 3.5-cm, elastic-hard, poorly mobile, nontender mass adherent to the Achilles tendon. Plain radiographs revealed a faintly calcified soft tissue mass without bone involvement. Magnetic resonance imaging showed a well-defined mass with 2 components with heterogeneous signal intensity, suggesting the coexistence of a fatty area and another nonlipomatous component. Marginal excision of the tumor was performed. Histologically, the tumor was composed of mature adipose tissue studded with islands of mature hyaline cartilage. Based on these findings, the tumor was diagnosed as a chondrolipoma. The patient had no evidence of local recurrence within 9 months of follow-up. To the best of our knowledge, this is the first case of chondrolipoma originating from the ankle in a child.

背景与目标： : 软骨脂肪瘤是脂肪瘤的一种极其罕见的变异型软骨化生。非脂肪瘤性成分的存在可导致放射学发现的鉴别诊断疾病中的各种实体。我们描述了一个9岁女性右脚踝发生软骨脂肪瘤的不寻常病例。体格检查显示跟腱附着有3.5厘米，弹性坚硬，移动不良，不柔软的肿块。X线平片显示微弱的钙化软组织肿块，没有骨受累。磁共振成像显示出一个明确的质量，其中有2个成分，信号强度不均匀，表明脂肪区域和另一种非脂肪瘤成分并存。进行了肿瘤的边缘切除术。从组织学上讲，肿瘤由成熟的脂肪组织组成，这些脂肪组织散布着成熟的透明软骨岛。根据这些发现，该肿瘤被诊断为软骨脂肪瘤。在随访的9个月内，患者没有局部复发的证据。据我们所知，这是第一例起源于儿童脚踝的软骨脂肪瘤。

BACKGROUND & AIMS: :A 4-year-old child with patent ductus arteriosus, perimembranous ventricular septal defect and ostium secundum atrial septal defect was successfully treated with the use of a simultaneous transcatheter for all of the anomalies present. The patent ductus arteriosus was closed first by using a coil, then the perimembranous ventricular septal defect was closed by using a 10-mm Amplatzer eccentric device. Finally, a 10-mm Amplatzer atrial septal defect device was implanted to treat the atrial septal defect.

背景与目标： : 一名4岁的动脉导管未闭，膜周性室间隔缺损和继发孔房间隔缺损的儿童，已成功使用同时经导管治疗所有存在的异常。首先使用线圈闭合动脉导管未闭，然后使用10mm Amplatzer偏心装置闭合膜周室间隔缺损。最后，植入了10mm Amplatzer房间隔缺损装置来治疗房间隔缺损。

BACKGROUND & AIMS: BACKGROUND:The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. METHODS:In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. FINDINGS:Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. INTERPRETATION:Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

背景与目标：

BACKGROUND & AIMS: :This paper will discuss the challenge of evaluating the efficacy of child bereavement services. Such services are being developed and it is essential that expansion is based on research and evaluation. A literature review details the limited research which has so far been conducted on such interventions. The paper then addresses four key components regarding child bereavement programme evaluation: preliminary evaluation of the Winston's Wish programme; the feasibility and validity of using an experimental method in the evaluation of child bereavement services; the identification of appropriate measures-what are we really attempting to measure with regard to child bereavement interventions; and the importance of measuring the family dynamics of grief-how can we incorporate the Dual Process Model?

背景与目标： : 本文将讨论评估儿童丧亲服务功效的挑战。此类服务正在开发中，扩展必须基于研究和评估。文献综述详细介绍了迄今为止对此类干预措施进行的有限研究。然后，本文讨论了有关儿童丧亲计划评估的四个关键组成部分: 温斯顿愿望计划的初步评估; 在评估儿童丧亲服务中使用实验方法的可行性和有效性; 确定适当的措施-我们真正试图衡量的是关于儿童丧亲干预措施的措施; 以及衡量悲伤的家庭动态的重要性-我们如何纳入双重过程模型？

BACKGROUND & AIMS: :As the conventional histopathologic examination of thymic carcinoma (TC) is nonspecific, immunohistochemical studies along with correlative radiographic investigations are needed for its correct diagnosis. TC commonly occurs in the late 5th to early 6th decades of life but is extremely rare in childhood. It may be incidentally detected from chest radiographs taken as routine or for other reasons. However, most patients present with symptoms such as chest pain, cough, shortness of breath, dysphagia and hoarseness, which are directly attributable to the mediastinal mass. Although TC frequently invades the neighboring organs, pleura and pericardium and metastasizes to the lymph nodes, liver and lung at the time of the first diagnosis, initial or late metastasis to the bone has been seldom reported in adults. Indeed, the English literature revealed no earlier report on initial bony metastasis in a child to date. We report a case of TC in a 12-year-old boy who initially presented with scapular osteolysis masquerading as a primary bone tumor to emphasize the usefulness of combined imaging for staging and histologic studies, particularly for such an unexpected case.

背景与目标： : 由于胸腺癌 (TC) 的常规组织病理学检查是非特异性的，因此需要进行免疫组织化学研究以及相关的影像学检查才能正确诊断。TC通常发生在生命的第5至第6年初，但在儿童时期极为罕见。可能会从常规或其他原因的胸部x光片中偶然发现。然而，大多数患者出现胸痛，咳嗽，呼吸急促，吞咽困难和声音嘶哑等症状，这些症状直接归因于纵隔肿块。尽管TC在首次诊断时经常侵入邻近的器官，胸膜和心包，并转移到淋巴结，肝脏和肺，但在成年人中很少报道初次或晚期骨转移。事实上，英国文献显示，迄今为止，没有关于儿童最初骨转移的早期报道。我们报告了一个12岁男孩的TC病例，该男孩最初表现为肩胛骨骨溶解，伪装成原发性骨肿瘤，以强调联合成像对分期和组织学研究的有用性，尤其是对于这种意外情况。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Recognizing the increasing commercialization and "brokerage" of organs for transplantation, the Transplantation Society has produced guidelines for organ distribution and donation of kidneys by unrelated living donors. The guidelines, reprinted here, include the stipulations that "organs should be transplanted to the most appropriate recipient on the basis of medical and immunological criteria," that sharing of organs should be arranged by national or regional networks, and that transplant surgeons should not advertise. In regard to donation by unrelated donors, the transplant team must determine that the donor's motives are altruistic; active solicitation of living unrelated donors is held to be "unacceptable," as is payment to a donor by the recipient or any supporting organization.

背景与目标： : 移植协会认识到用于移植的器官日益商业化和 “经纪”，为不相关的活体捐赠者的器官分配和捐赠肾脏制定了指南。此处转载的指南包括以下规定: “应根据医学和免疫学标准将器官移植到最合适的接受者”，器官共享应由国家或区域网络安排，并且移植外科医生不应做广告。关于无关捐赠者的捐赠，移植小组必须确定捐赠者的动机是无私的; 积极征集活着的无关捐赠者被认为是 “不可接受的”，接受者或任何支持组织向捐赠者付款也是如此。

BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

背景与目标： : 世界卫生组织欧洲地区是世界上耐多药结核病 (mdr-tb) 发病率最高的地区之一，每年都有许多易受感染的儿童。耐多药结核病暴露后预防性治疗的证据有限，目前的指导意见存在矛盾。进行了基于互联网的调查，以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛选和决策相关的实践变化很大。刚刚超过一半的人为暴露于耐多药结核病的儿童提供了预防性治疗; 与提供相关的唯一特征是欧盟内部的实践 (调整或4.07，95% CI 1.33-12.5)。

BACKGROUND & AIMS: :We report the fourth observation of Hb Sallanches [alpha104(G11)Cys-->Tyr, TGC-->TAC (alpha2)], an unstable alpha chain variant of intermediate severity in the homozygous state. Heterozygosity occasionally produces mild hypochromia and microcytosis in some patients. A balanced beta/alpha ratio, found in previously reported cases, points to unstable alphabeta dimers formed as a result of the Cys-->Tyr substitution at the alpha1beta1 contact site in this hemoglobin (Hb) variant. Our patient, and the previous two of the three cases reported in patients of Pakistani origin, points to a common population stock, separated by the mass population migration which occurred during the partition of Pakistan and India in 1947.

背景与目标： : 我们报告了Hb Sallanches [alpha104(G11)Cys->Tyr，TGC->TAC (alpha2)] 的第四个观察结果，这是纯合状态中中等严重程度的不稳定 α 链变体。在某些患者中，杂合性偶尔会产生轻度的低色和微囊症。在先前报道的病例中发现的平衡的 β/α 比指出，由于该血红蛋白 (Hb) 变体中alpha1beta1接触位点处的Cys->Tyr取代，形成了不稳定的alphabeta二聚体。我们的患者，以及巴基斯坦裔患者报告的三例病例中的前两例，都指出了一个共同的人口存量，被巴基斯坦和印度1947年分治期间发生的大规模人口迁移所分隔。

BACKGROUND & AIMS: :Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening, adverse effect of heparin therapy. Patients with this complication require an alternative approach to anticoagulation. Bivalirudin is a direct thrombin inhibitor with an efficacy comparable to that of heparin, a short half-life, and reduced bleeding complications in adults. We present the case of a 2-year-old boy with HIT Type II who underwent recanalization of an occluded superior vena cava and stent placement, utilizing bivalirudin as anticoagulant.

背景与目标： 肝素诱导的血小板减少症 (HIT) 是肝素治疗的潜在威胁生命的不良反应。患有这种并发症的患者需要另一种抗凝方法。比伐卢定是一种直接凝血酶抑制剂，其疗效与肝素相当，半衰期短，并减少了成人的出血并发症。我们介绍了一个2岁的II型HIT男孩的病例，该男孩利用比伐卢定作为抗凝剂进行了闭塞的上腔静脉再通和支架置入。

BACKGROUND & AIMS: :Our institution has used the DeBakey VAD Child as a bridge to heart transplantation in select pediatric patients. Pump thrombus is a potentially serious complication with few available treatment options. Only surgical device exchange or the use of tissue plasminogen activator are reported in the literature. We report the use of clopidogrel as an alternative thrombolytic agent in the presence of pump thrombus in an adolescent patient with a DeBakey VAD Child heart pump.

背景与目标： : 我们的机构已将DeBakey VAD儿童用作某些儿科患者进行心脏移植的桥梁。泵血栓是一种潜在的严重并发症，几乎没有可用的治疗选择。文献中仅报道了手术设备交换或组织纤溶酶原激活剂的使用。我们报告了在患有DeBakey VAD儿童心脏泵的青少年患者中，在存在泵血栓的情况下使用氯吡格雷作为替代溶栓剂。

BACKGROUND & AIMS: :We encountered an extremely unusual presentation of proptosis in a 7-yr-old boy due to psammomatoid juvenile ossifying fibroma of frontoethmoidal region. The tumor also led to development of mucocele in the frontal sinus not yet fully developed as on opposite side.

背景与目标： : 我们在一个7岁男孩中遇到了极不寻常的眼球突出现象，这是由于额筛区的类膜样少年骨化纤维瘤所致。肿瘤还导致额窦粘膜囊肿的发展，而另一侧尚未完全发展。

BACKGROUND & AIMS: :A comprehensive meeting on current aspects of DNA repair organized by, Jochen Dahm-Daphi, Ekkehard Dikomey, Alexander Bürkle, Marlis Frankenberg-Schwager, Frank Grosse, Andrea Hartwig, George Iliakis, Bernd Kaina, Jürgen Thomale, and Lisa Wiesmüller was held in Hamburg, Germany from 12 to 15 September 2006. This article summarizes information of invited lectures and proferred papers of six plenary sessions.

背景与目标： : 由Jochen Dahm-Daphi，Ekkehard Dikomey，Alexander b ü rkle，Marlis Frankenberg-Schwager，Frank Grosse，Andrea Hartwig，George Iliakis，Bernd Kaina，j ü rgen Thomale和Lisa wiesm ü ller组织的关于DNA修复当前方面的综合会议于12日至2006年9月15日在德国汉堡举行。本文总结了六次全体会议的邀请演讲和论文的信息。

BACKGROUND & AIMS: :Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

背景与目标： : 针对乙型肝炎病毒的疫苗接种很少与扁平苔藓有关。我们报告了一名来自尼泊尔的儿童的此类案件。一名12岁男孩在第二剂乙型肝炎病毒疫苗接种六周后出现了全身发痒的紫红色丘疹和斑块。血清HBsAg和HBeAb均为阴性，但HBsAb为阳性。在加强剂量的疫苗之后，出现了普遍的，类似的爆发的新作物。所有病变在全身类固醇治疗后三个月内消失。随访1年后无复发。对这种关联的认识是必要的，尤其是在儿童中，因为疫苗接种运动正在增加。