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June 21, 2020

Exploring TIM3 Inhibitors as a Promising Partner for Immune Checkpoint Inhibitors

T cell immunoglobulin mucin-3 (TIM3) was first discovered in 2002 and is a member of the TIM family of immunomodulatory proteins. TIM3 has attracted much attention because it is related to the regulation of autoimmunity and immune response in cancer. In recent years, the development of TIM3 inhibitors is also steadily proceeding, with a view to solving the problems of low response rate and drug resistance of existing immune checkpoint inhibitors.

Immunosuppressive drugs effect of TIM3 in tumor microenvironment

TIM3 was originally thought to be a receptor expressed on CD4+ and CD8+ T cells that produce interferon-γ, and TIM3 expression was subsequently found in many other types of cells, including regulatory (Treg) T cells , Myeloid cells, natural killer cells and mast cells. Therefore, TIM3 targeted therapy may modulate the immune response by acting on multiple cell types.

TIM3 can inhibit T helper cells (Th1 and Th17) in the tumor microenvironment, induce CD8+ T cell depletion, promote Treg cells to become a highly immunosuppressed cell population, and promote bone marrow-derived cells with powerful T cell immune response suppression functions. A large number of inhibitory cells (MDSCs) expand, promote innate immunosuppression, and tumor immune escape.

The specific role of TIM3 in non-T cell leukocytes is summarized in the following table:

Advances in clinical research of TIM3 block therapy

In the preclinical model, the combined blocking therapy of TIM3 and PD1 is superior to monotherapy, which can improve the anti-tumor T cell response of patients with advanced cancer and can lead to tumor regression.

Recently, a number of clinical trials of TIM3 blocking therapy alone or in combination with other therapies have been carried out (one of which is a clinical trial of bispecific antibodies designed for PD-1 and TIM3), involving many types of tumors. Advanced malignant tumors, such as acute myeloid leukemia (AML), lymphoma, liver cancer, and non-small cell lung cancer, are summarized in the following figure:

Ongoing and planned clinical trials of anti-TIM3 drugs
(Picture from reference 2)

TSR-022 is the first anti-TIM3 drug to publish experimental data. This is a humanized anti-TIM3 IgG4 antibody developed by Tesaro. Monotherapy with TSR-022 resulted in 31 patients with stable disease (SD), 1 patient with leiomyosarcoma had partial response (PR), and no dose-limiting toxicity was observed.

The effectiveness of TSR-022 single drug has opened the door to hope for subsequent combination therapy with PD-1 antibody. In 202 cases of non-small cell lung cancer patients refractory to PD-1/PD-L1 antibody, when used in combination with a fixed dose of TSR-042 (a PD-1 antibody), as the dose of TSR-022 increased Its clinical activity is also increasing (represented in the proportion of SD or PR patients). Most importantly, this combination therapy is also well tolerated, with no dose-limiting toxicity observed.

Recently, Eli Lilly's TIM3 blocking antibody LY3321367 and Novartis' anti-TIM3 antibody MGB453 have been reported to have successfully passed Phase I clinical trials. Consistent with the preclinical model, the combined blocking therapy of TIM3 and PD1 is superior to monotherapy.

These existing data indicate that TIM3 is indeed a "checkpoint" receptor. Inhibiting TIM3 can enhance the anti-tumor effect of PD-1 blockers, and is expected to become the next strength partner of PD-1 block therapy for tumor patients. Bring more treatment options and hope. I also hope that these ongoing clinical trials will bring us more good news.

references:

[1] Tao Jinglian, Li Lijuan, Shao Zonghong. Research progress of the role of TIM3 in tumor microenvironment [J]. Chinese Journal of Immunology, 2016, 32(7):1070-1073.

[2] Wolf Y, Anderson A C, Kuchroo V K. TIM3 comes of age as an inhibitory receptor[J]. Nature Reviews Immunology, 2019: 1-13.

June 19, 2020

Emerging Challenges to Adolescent and Young Adult Sexual and Reproductive Health

June 18, 2020 - Social alienation and limited access to contraception and abortion services during the COVID-19 pandemic are affecting the sexual and reproductive health of adolescents and young adults, according to a new study by researchers at Columbia University's Mailman School of Public Health and Columbia University.
Rutgers University.
The researchers looked at how to deal with these challenges as well as peers and relationships.
The findings were published in the journal Perspectives on Sexual and Reproductive Health.

Dramatic changes in adolescents and young adults include school closures, possible increases in family time, interruptions in normal trajectories towards increased independence, and very limited or no physical contact with sexual and romantic partners.

Although the pandemic may reduce opportunities for some young people to have sex, interruption of contraception and abortion may remain a significant problem for adolescents and young adults who are able to remain close to their partners during the pandemic, the authors note.
"The good news is that certain services can be addressed through telemedicine, including access to multiple forms of contraception and testing and treatment for sexually transmitted diseases," said Lesley Cantor, professor and chair of the Department of Global Public Health at Rutgers.
"If telemedicine remains as widely used as it was during the pandemic, young people's access to sexual and reproductive health may actually improve."
However,

There is not much data on testing for sexually transmitted infections or seeking abortion treatment specifically for young people.
But despite the clear evidence that abortion is essential and needs to be timely, many states have tried to limit its use by limiting abortion.
The drop in vaccination rates for all children over the age of two is also worrying, with the use of the HPV vaccine, which protects against cancer-causing infections and precancerous infections, plummeting.

LGBTQ youth are also affected, although fortunately, many LGBTQ centers quickly moved support groups and other services online.
Services such as QChat Space are already using digital platforms to convene and support LGBTQ youth.
However, for some young people whose families are not receptive, months of isolation can lead to serious tensions and confidentiality issues, which may further isolate LGBTQ youth.

The social disruption caused by the pandemic affects young people's health and well-being, but one positive aspect is that young people are digital natives familiar with online platforms and social media.
"Young people are supposed to be independent at this time, so maintaining distant relationships with friends and romantic partners can be particularly challenging for those who have to return home after a period of time.
We think their continued digital connectivity is now working against them and now positive for them."
David Bell, MD, associate professor of population and family health and pediatrics at the Maiman School of Public Health in Columbia.

June 18, 2020

Hepatitis B Treatment: Interferon vs. Nucleoside Analogues

In the antiviral treatment of hepatitis B, interferon or nucleoside, which is the preferred drug?

To prevent the replication of hepatitis B virus, we can have antiviral treatment, and can alleviate the inflammation of liver tissue, reduce the risk of patients to develop liver cancer, so antiviral treatment is the most important for chronic hepatitis B patients.

Nowadays, there are two kinds of antiviral treatments for hepatitis B: interferon and nucleoside.

So how should the patient choose?

Is interferon the first choice for patients?

  1. Interferon

Learn about interferons

Interferon is divided into peg-interferon and ordinary interferon, it is the earliest against hepatitis b virus drugs in clinical application, its mechanism of action is to strengthen the body's antiviral immunity, it itself is a kind of protein, not eliminate the virus, it need to be with people inside the cell surface to produce interferon receptor combination, make the body's own cells to produce antibodies, reach the purpose of preventing HBV replication, in addition, interferon can strengthen immunity, increase immunity, and the way we can by injecting drug delivery.

  1. Nucleoside analogues

Learn about nucleoside analogues

The drugs for clinical application in the late 1990 s, it can directly kill the virus, from the short-term effect, it is better than that of interferon, so after the drug application and get the favour of the patients, the mechanism of action of nucleoside analogues is by interfering with HBV nucleoside acid metabolism directly inhibit the replication of the hepatitis b virus, it can be taken by mouth, now at the beginning of the new guidelines recommend cure preferred nucleoside analogues as: entecavir (ETV), tenofovir ester (TDF) and fumaric acid drug tenofovir (TAF).

After comparing the two drugs, we can find that both drugs have their own advantages and disadvantages, and we need to choose according to our own needs.

Liver luo xin pill -- a Chinese patent medicine for kidney tonifying nourishing the liver and anti-liver fiber, with a full prescription of 20 medicines, has an exact effect on chronic hepatitis b, liver fibrosis and early cirrhosis patients:

First, it can significantly improve the clinical symptoms, such as fatigue, waist and knee weakness, abdominal distension, dry mouth, etc.

Second, relieve liver inflammation and improve liver function;

Thirdly, it can resist liver fibrosis and inhibit the progression of cirrhosis.

Please take the medicine according to the doctor's advice

June 16, 2020

PCT Guidelines for Antibiotic Management: Asia-Pacific Expert Consensus Outline

Procalcitonin (PCT) is an early diagnostic marker for severe bacterial infection and sepsis with diagnostic and prognostic properties.
Pct-guided antibiotic management has been shown to reduce antibiotic use and improve clinical outcomes.
Expert consensus on PCT guidance for antibiotic management has been published in Europe and the United States to provide guidance for the use of PCT guidance for antibiotic treatment.
However, due to differences in infection types, patient populations, available resources and clinical standards in asia-pacific countries, the guidelines in the consensus need to be revised in order to be applicable in asia-pacific countries.
Using Delphi method, the Asia-Pacific expert group reached two consensus on the application of PCT in critical and non-critical patients.

The use of PCT to guide antibiotic management in patients with acute respiratory infections and sepsis is also applicable in the Asia-Pacific region.
The application of PCT in non-severe (mild to moderate) and severe (severe) patients is shown in Figure 1 and Figure 2.

First, patients should be stratified according to clinical criteria and probability of bacterial infection (infection is uncertain and highly suspected).
Then, the PCT level was applied to evaluate the patients, and the critical PCT value of non-critical patients was & LT;
0.25 mu g/L;
The critical PCT value of severe patients was & LT;
0.5 g/L suggests low possibility of bacterial infection.

Low PCT levels are not recommended in non-severe patients with low risk of bacterial infection.
In critically ill patients undergoing empirical antibiotic treatment, PCT should be revisited 6-24 hours later to reassess the need for antibiotic treatment.
Therefore, the purpose of PCT testing in critically ill patients is to discontinue antibiotics rather than to enable antibiotic therapy.

Continuous testing of PCT levels to monitor responses to antibiotic treatment and infection control is recommended for patients starting empirical antibiotic therapy.
When PCT level drops from peak & GT;
When 80% and/or below the critical value and the patient is clinically stable, early discontinuation of antibiotics is recommended.

Due to the lack of systematic PCT guidance and antibiotic management studies in patients with clinically suspected tropical diseases such as malaria, dengue fever, haemorrhagic fevers and other diseases with high prevalence in the asia-pacific region.
The panel noted that management of these patients should be based on clinical evidence and international recommendations, and that PCT should not be used to guide any antibiotic use decision.

For outpatient and emergency patients, initial PCT levels help assess the likelihood of bacterial infection and the need for antibiotic treatment.
Highly sensitive real-time diagnostic equipment enables rapid decision making.
 

Integrating PCT into antibiotic management can improve the diagnosis and management of patients with respiratory infections and sepsis, reduce the global bacterial resistance crisis and provide guidance for more personalized treatment decisions in asia-pacific countries where antibiotic overuse is a serious problem.

June 13, 2020

Germany, France, Italy, and the Netherlands Order 300 Million Doses of COVID-19 Vaccine from AstraZeneca

Germany, Along with France, Italy and the Netherlands, has signed a contract with Astrazeneca to purchase at least 300 million novel Coronavirus vaccines in advance, the Federal Health Ministry said Wednesday.
In the best case scenario, the Novel Coronavirus vaccine could be completed by the end of this year, the Federal Ministry of Health of Germany expects.

Astrazeneca, headquartered in London, Is a global biopharmaceutical company.
Germany's Federal Health Ministry confirmed the news the same day, according to German TV 1 and frankfurter Allgemeine Zeitung.

The vaccine ordered by the four countries is AZD1222, which is under development at Oxford University and is produced under licence by Astrazeneca.
The vaccine is currently being tested on a large scale.
German media reported that the above-mentioned four countries have signed orders with Astrazeneca for no less than 300 million doses of vaccines, with a maximum of 400 million doses.
Although the four countries are Germany, France, Italy and the Netherlands, the vaccine will be available to all EU members and is expected to be distributed according to population size.

Astrazeneca has recently reached similar agreements with the UK and the US respectively, according to The German Business Weekly.

A German TV, citing the German federal health minister jens pan said, many countries in the world has to ensure that their vaccine supply, however, Europe also didn't do that, "by the rapidly coordinated action of several eu member states, eu citizens to all of us to benefit in the outbreak of the crisis".

Germany's Federal Health Ministry said today that the four countries are holding talks with potential vaccine makers to sign a deal to ensure production capacity so that vaccines can be shipped to the European Union in large quantities.
In addition, the video conference of eu Health ministers held on December 12 also agreed that the "vaccine Alliance" will carry out action in coordination with the European Commission.

The EU has recently invested heavily in speeding up vaccine development and ensuring supplies.
On November 11th the European Investment Bank (EIB), the EU's multilateral lending arm, announced a €100m investment in BioNTech, a vaccine company based in Mainz, Germany, to boost its vaccine research and production.
According to German media, the European Commission wants to ensure that sufficient quantities of vaccines can be obtained quickly for EU citizens by signing pre-purchase agreements.

June 10, 2020

Former President of Slovenia Advocates for Making Vaccines a Global Public Good

Danilo Turk, former President of Slovenia and chairman of the World Leaders' League, said on Thursday that international cooperation is the most important factor in the global economic recovery and it is of great significance to make vaccines a global public good.

On the same day, While attending the Global Think tank Cloud Forum on CoVID-19 Cooperation, Turk said that the "shock" of coVID-19 has swept the world and many countries, including China, have made heroic efforts to defeat the epidemic.
Entering a new stage of development, mankind has undertaken major missions in various fields, including medical treatment and economy.

Turk noted that the recent World Health Assembly established a very comprehensive plan for combating the epidemic, which includes a lot of international cooperation.
"Addressing many of the current and potential challenges takes place simultaneously in the context of international cooperation and competition, where better management, particularly in vaccines, is critical."
He says there may be a lot of competition between different research institutions and different countries, and there is a great need for collaboration.

"We need to think about the global availability of vaccines, and in that sense it makes a lot of sense for vaccines to be a global public good."
"That means we need to make vaccines globally accessible, affordable for governments in low - and middle-income countries," Turk said.

In addition, Turk said new features are emerging throughout the epidemic, such as how to ensure global supply chains.
"It's not just an economic issue, it's a process of action, and it requires some policy, decision support."

To achieve this, Turk said, "low - and middle-income countries need policy assistance, and institutions like the IMF can be involved, and we need that cooperation."

In Turk's view, every country may encounter a common situation, which is the problem of employment.
"It is a priority to ensure that the world does not slide into a serious crisis."
Turk said that the employment problem has been very serious in some countries, but China has made very positive progress in solving the employment problem.

"We are seeing developments on the domestic demand side in China and some of the demand is coming from smes.
Most of this is driven by domestic demand."
Turk noted that many countries around the world need to understand the details of China's current economic recovery.
"China has made a commitment to quality development as the main direction for the future, including the development of the entire healthcare system."

"This is a difficult time for the world, but it is also a time of great opportunity."
"We want to do our best to build a more resilient, people-centric economy," Mr. Turk said.

June 8, 2020

Should You Consider HGH Injections?

How tall will the child grow in the future?

If you are not tall, are you destined to only get "genetic height", or can you turn things around through intervention?

Can a bone age test provide early access to a medical protocol that can help the child's height?

.

I'm sure every parent has a long list of questions about their child's height.
Xiao Mei recommends this height collection for everyone.
Because of her small size, the author pays special attention to the height of her two children. Recently, she interviewed a specialist in short stature at the First Zhejiang Hospital.
The questions about height, including whether to use genotropin growth hormone to boost a child's height, are well understood through 14 questions that parents care about most.

Because it's so useful, I have to share it with you. The message from this article is clear: if your baby is undersized and showing signs of early development before the age of 10, take him to a professional doctor as soon as possible, and intervene as soon as possible.

The article is relatively long, and the dry academic content has been bypassed. It is practical and easy to understand. First, give the key points, and then we will read slowly:

  1. Babies tend to be short before they develop, so is it difficult for them to leap up the day after tomorrow?

2 parents are not tall, baby is shorter than the same age, can play growth hormone?

  1. The child's height development is normal, but the parents of the child's height expectation is relatively high, can you play?
  2. At what age is it safer to get involved?
    Is there a big difference between early intervention and late intervention?
  3. What kinds of growth hormones are available in the market and how much do they cost?

…

The heat has been very high "youth with you 2" finally ended last week, in addition to the full screen of long legs envy, for the photo in The height of CAI Xukun is also let me very sigh, standing in the first row, and the second row of girls shoulder to shoulder, grow tall really have advantages ah ↓

Look at the face of the society, the appearance of the image, height is really in the employment, the choice of a spouse in the direct impact.

The height of 182 of the world elder sister Zhang Zi Lin, 3 years old daughter height has reached the waist of the mother, height advantage breakthrough sky

The long legs of lu Yi's family are so good that they are in a coma

People Shared on Zhihu: 1.9m tall, interview a professional question was not asked, easily into the central enterprise ↓

Some netizens said his experience: because the height condition is good, in the unit all the more attention, exercise opportunities, the growth rate is fast ↓

And having been a Hobbit for forty years, I am particularly struck by the question of stature.
Because of occupation, height has a great influence on career development.
When I just entered this industry, there were so many opportunities and platforms. If I could grow another 10 cm, I believe now I am far more than a news producer and announcer.

Female anchors took photos, a group of 170-height goddess in order to take care of me, can only such a body to take photos ↓

Nature is not good, the day after tomorrow to make up, for the two children's genetic height, I have been very worried.
My brother later predicted 172, and when they grow up, it's hard to say whether they will be in the same situation as Me.
I've been debating whether to give him growth hormone or not

Want to use medical intervention, with the topic of growth hormone, in our group attention has been very high, from time to time will be discussed by everyone, not tall old mother in order to the child's genetic height simply worried heart, ↓

Like many parents, we have been "loving and worried" about growth hormones.
Faced with two completely different voices, do you have as many question marks as I do?

Last week, I had an exclusive interview with Wang Chunlin, an expert in pediatric dwarfism and endocrinology and chief pediatrician in Zhejiang I Hospital.

Chun-lin wang

Doctor of Medicine, chief physician, postgraduate supervisor, director of pediatrics, the first Affiliated Hospital of Zhejiang University School of Medicine, director of neonatology, graduated from Zhejiang University.
He has been engaged in clinical, scientific research and teaching of pediatric internal medicine diseases for more than 20 years, mainly engaged in genetic and clinical research of endocrine diseases such as short stature, growth hormone deficiency, obesity, etc.

On the same day of the interview, Director Wang Chunlin happened to be a guest on the live program of "Chinese Children's Growth, Development and Health Communication Action" hosted by People's Daily, answering parents' questions about their children's height and development.
After watching the whole live broadcast in person, I consulted Director Wang exclusively on some issues of special concern to parents in the circle of mothers.

A word of caution: today's tweets are a bit long, but they're practical, easy to read and full of good stuff!
In an effort to steer clear of dry academic content, Riyo compiled the article to address parents' primary concerns.
Director Wang answered the following questions in detail:

1 parents are not tall, baby is shorter than the same age, can play growth hormone?

2 baby height development is normal, but parents to child height expectation is higher, whether can you fight?

3 How many years old intervene to compare insurance?
Is there a big difference between early intervention and late intervention?

  1. Which growth hormone can be selected in the market at present, and how much is the cost?

Does taking growth hormone increase the risk of fracture in adulthood?

  1. How to balance the risks and benefits brought by drugs?

.

Growth hormone - "effects" and "risks.

Growth hormone as a cure for short stature and other problems, its magic "special effect", and behind the "risk" has been the root cause of parents struggle.

Lionel Messi, the famous Argentine star, is a typical beneficiary.
He started taking growth hormone injections at the age of 12 and grew from 1.4 to about 1.7.

He said his parents gave him the injection at first, but after he learned to do it himself, he always gave it to himself.
He said with a smile that the injection was similar to a pen stick, with a small needle and no pain.

The pen-like syringe is common in China and is commonly used to inject insulin and growth hormone.

Others said they had grown 19cm from 147 to 166 after being injected with growth hormone, the most money their parents had ever spent.

But not everyone who gets growth hormone can achieve such ideal effect, some children, after using the drug, only grew 3cm long

The boy is 15 years old. His father is 180cm and his mother is 165cm. However, the 15-year-old is only 160cm.

Bone age tablets showed that the epiphyseal line of Xiao Wu was now semi-closed, and even with growth hormone treatment, her height would not increase more than 5cm at most.
The parents wanted to make a final effort: "Try doctor, how much taller you can be, is better than nothing!"

In this way, after half a year of medication, Xiao Wu's height only increased by 3cm. The bone age film taken last month showed that the bone scale line had been completely closed, and the lifetime height was fixed at 163cm.

Not that the effect varies from person to person is the key, parents are the biggest worry, tall, but with other adverse reactions to trade ↓

In the face of two completely different voices, how should parents scientifically understand growth hormone and make the judgment that suits their baby?
The following part of director Wang Chunlin's exclusive interview may help you.

Increased growth hormone, suitable for your family?

  1. What evaluations does the doctor perform?
    What is the basis for intervention and medication?

There are so many things to assess, bone age, annual growth rate, pituitary space-occupying lesion, blood routine, blood sugar, liver and kidney function, thyroid function, drug stimulation…
All need comprehensive evaluation!

Growth hormone drugs to stimulate, in particular, is made of the need to be hospitalized, it will be altogether five times, see the highest in the secretion of growth hormone (because of the growth hormone secretion, a pulse type high will be low, the secretion of day is lower, normal is not to come out of, only after excitation with medicine, can see that it maximum secretion).

If the peak is more than 10, the child's growth hormone secretion is normal;
A peak of less than 10 indicates a deficiency of growth hormone, which requires intervention and supplementation.

  1. Is it true that it doesn't matter if you're shorter when you're a child, you'll pop up when you hit puberty?

Unfortunately, if a child is consistently short until he or she develops, the 'leap up' becomes more difficult.

But there are exceptions.
For example, Director Wang told me, small when short, but later development late, to high school, even the university is still growing, this kind of situation belongs to the delay of physical puberty in medicine.

The most obvious characteristic is shorter than their peers, but not particularly short, just caught in the lowest standard, reached the level of p3, such children often his development has always been along the p3 in this line, at the same time every year a 5 cm long, keep in the growth rate of the lower limit (the standard rate in 5 ~ 7 cm/year), their age of puberty, he didn't also development, it belongs to the later development.

I intercepted this director Wang said P3 line, everyone reference ↓

In addition, director Wang also mentioned late development is a very important basis -- family genetics, namely parents, brothers and sisters, maternal grandparents, maternal grandparents…
There are not many people of late development in lineal lineages.

If more, that child late development rate is still relatively high, which means later growth;
But if there are no late bloomers in the family, and the parents themselves are short, it may be too optimistic to hope for a higher puberty.

  1. Do children with late development need to be injected with growth hormone?

This depends on his "late" to what level, it is recommended that parents take their children to the hospital as soon as possible diagnosis.

Many children are considered by their parents to be late in development from an early age and do not intervene until they reach their ideal height at puberty.

Wang, give me an example: 10 ~ 11 year old boy, only 1 meter height 35, after the development in the role of sex hormones, the original backward bone age 1, 2 years, now just six months will take to speed up the epiphyseal closure, it needs to develop after only 25 to 30 cm long, add up to an optimistic situation is only 1 meter 65, parents must accept.

At this time, intervention is late intervention, and the only treatment option is:

  1. Inhibit gonadal development with drugs;
  2. Combined with recombinant human growth hormone therapy to improve the growth rate of children.

When both drugs are used at the same time, the child's suffering and the cost to the parent is far greater than the early intervention.

With early intervention, the situation would be completely different: the child's height and growth hormone would be the same as that of his peers after three to five years of treatment in the early stage of development, and then the comparison would be made. If the puberty reached the normal level of development, the parents would not have to worry later.
Therefore, parents should follow the principle of early detection, early diagnosis and early intervention for this part of the children, and should not blindly wait and miss the best intervention opportunity for height.

4, why parents are normal height, but the child is short?

There are many factors contributing to this, such as genetics.
A child born to a normal height parent with an invisible genetic condition has a one-in-four chance of developing the condition, which can make the child shorter.

Another condition is early development.
In particular, one of the parents is normal height, the other is short, the child's early height has been at the level of P3 ~ P5, such children must pay attention to, once the emergence of early development, that is undoubtedly a further insult, because the entire adolescence also grow 20 cm (girl), the foundation is not enough, lifetime height will not be very ideal.

Developmental characteristics of boys' secondary sexual characteristics

Girls secondary sexual characteristics development characteristics ↓

Here, Director Wang told me more regrettably: early short stature + premature, the cost is very large, finally can only as the above mentioned case, the use of inhibitory development + injection of growth hormone treatment.

  1. What is the effect of intervention for children with early development?

Director Wang Shared with me a case in which he was particularly impressed:

Is a little girl, the mother only 1.5 meters, the father 1.63 meters, she was short, and 7 years old on the development, genetic height is only 1.5 meters.
After 3 years of treatment, the final height of 1.6 meters, should say or very ideal.

6, a healthy, normal height child, but the parents have a higher expectation of his height, in such a case can inject growth hormone?

If the child is doing well, there is no need to intervene.

What parents should do more is to establish a healthy lifestyle for their child, develop good habits in nutrition, exercise, sleep and so on, and then see what happens in adolescence.
There is no need to be overly anxious if the child is doing well in adolescence.

Zhang Liang son every day, Tian Liang daughter sen Dish bubble in the stadium since childhood big, big long leg no problem

  1. The mother is 1.58 meters and the father is 1.70 meters. The child has inherited the height of 1.70 meters.
    Can growth hormone be used to intervene?

If the parents have a strong desire to intervene and the child has not reached the genetic height or expected height by the end of adolescence, a bone age can be taken to see how much he can expect to grow. If the situation is not ideal, a final rush with growth hormone is also clinically possible.
It is recommended that parents take their children to regular hospitals for examination before medical intervention.

70 percent of a child's height is inherited from his or her parents

  1. Are there any signs of late adolescence?
    How can parents tell if a child is in late adolescence?

The main feature is a slowdown in growth rate.
For example, before 1 cm long, now 3 months only grow less than 2 cm, that means that the growth period of the child is almost over, this time must grasp the final treatment opportunity.

Must not wait until a bit is no longer long, bone age piece discovers epiphyseal line already closed, that has no way.
So adolescent height management is very important, parents must be timely attention.

Suggest parents stick a height ruler on the wall at home, pay close attention to the child's height

  1. Does it mean that if the parents are willing to intervene, the children can be injected with growth hormone in late adolescence?

Whether or not to use growth hormone injection therapy, is based on the child's current height, genetic height, changes in the child's growth rate, bone age, and so on to determine the overall.

For example: boys genetic height of 1.72 meters, late puberty 1.66 meters, this height in the population is normal, but has not reached the genetic height, then this part of the children and parents if the height requirement is high or can consider drug treatment.

  1. Some netizens (female, now an adult) Shared their experiences with ghrelin in adolescence and broken bones in adulthood, suggesting a connection between the two.
    Is it reasonable to worry that "playing growth hormone will cause fracture"?

Wang said there are many causes of fractures.
Growth hormone therapy can affect bone metabolism, and there is no evidence that childhood growth hormone therapy leads to an increased incidence of fracture in adulthood.

In addition, he also said: outdoor exercise in adolescence is also very important, the amount of exercise has a great impact on bone metabolism, this is the peak of metabolism, a more typical situation is the growth pain of a child growing fast, indicating that his metabolic demand is increasing, it is appropriate to supplement vitamin D.

  1. What growth hormones are available on the market?
    What are their characteristics?

There are three main types: long-acting growth hormone (through independent research and development in China, the world's first pegylated long-acting growth hormone has been born, which was developed by Jinsei Pharmaceutical And marketed in 2014), short-acting growth hormone powder and short-acting growth hormone injection.

Long-acting growth hormone: only one injection per week, the least of all the growth hormone injections, once a week, only 52 injections per year, so that the children no longer need daily injections, greatly improving the medication compliance of short stature children.
Long-acting growth hormone is much less painful to administer than short-acting growth hormone, which requires 365 days of injections, and is more medically preferable to short-acting growth hormone.
But long-acting growth hormone treatment is also more expensive for shorter duration.

Short-acting growth hormone should be injected daily. There are two main types:

One is short-acting powder.

In 1998, the first growth hormone powder in China was introduced, and the expression technology of Escherichia coli secretion was adopted.
However, due to the limitations of technology at that time, the stability of growth hormone could only be maintained through the freeze-drying process.
The freeze-drying process destroys the original spatial structure of growth hormone and increases the content of relevant substances.
In the course of the use of powder, the process of redissolution also makes the content of relevant substances increase, easy to produce antibodies, long-term efficacy reduced;
In addition, in the process of using the powder, the operation is also very complicated, requiring daily injection, which results in poor patient medication compliance and reduced long-term efficacy. However, the price of the powder is relatively the cheapest.

The other is short-acting injection, the first growth hormone injection in Asia was listed in 2005 (Changchun Jinsai Pharmaceutical Co., LTD.).
Using the protein liquid stabilization technique, which does not require freeze drying and redissolution, the growth hormone water agent can be completely consistent with the natural growth hormone.
Water agent activity is higher, will not produce antibody, can guarantee curative effect.

It is easy to operate and easy to use by using the matching hidden needle electronic pen, which is suitable for long-term use by children.

Electronic operation, accurate dose, stable injection, adjustable speed, can reduce the injection pain;
The design of hidden needle structure can't see the needle during the whole injection process, eliminate the fear of injection and increase the compliance of patients;
Electronic operation, easy to use, suitable for long-term use of children.

It's easy for parents to coax their kids into thinking it's a daily energy bar.
Wang says one of his patients is a 7-year-old who can play after a month of study. That's the convenience of the syringe pen.

In order of efficacy, long-term effect is better because of better compliance and shorter effect.

  1. How should parents choose the three growth hormones?
    Is there much of a difference in cost?

Long-acting growth hormone, which is injected only once a week, significantly reduces the pain of daily injections compared to short-acting growth hormone, which is injected 365 days a week, and greatly improves medication compliance.
Therefore, Wang said that long-acting growth hormone treatment is more effective than short-acting treatment.

Short-acting water agent with hidden needle electronic pen, water agent to maintain the natural structure of growth hormone, will not produce antibodies, and added antibacterial agent, to ensure long-term injection safety.
Hidden needle structure design, to eliminate the fear of children injection, electronic intelligent design to ensure long-term safe and convenient operation of patients.

Short-acting powder changed the original spatial structure of growth hormone, and was easy to produce antibodies.
In addition, during the use of powder, the operation is also very complicated, requiring daily injection, which results in poor medication compliance of patients and reduced long-term efficacy.

Therefore, in terms of medication compliance, long-acting growth hormone > short-acting water agent > short-acting powder is the cheapest, short-acting water agent is slightly more expensive than powder, and long-acting water agent is more expensive than the other two dosage forms.

Where can I buy growth hormone on the market now?
If the child is treated in a public hospital, are all three growth hormones available?

Growth hormone is peptide medicaments, drugstore cannot sell, the outpatient department that has qualification only hospital and medical establishment has, and need to issue doctor's diagnose a book, state case, dosage, prescription to wait clearly.

  1. There are already parents in liyou's mother circle giving their children growth hormone treatment. What should these parents pay special attention to?
  2. Timely treatment and medication.

2, nutrition, diet, exercise, sleep and other factors conducive to the growth of children have to keep up.

  1. Compliance, which is also what Director Wang expressed his greatest concern.
    Some parents stop and stop, which is very bad.
  2. Timely review and evaluation should be conducted in accordance with the doctor's requirements during the treatment. The nodes are the first month, the third month and every three months thereafter.

Why should you check in time?
The main thing is to look at the efficacy and safety of the drug.
Once there is any problem midway through treatment, you can intervene in time.

I hope the next generation has a pair of proud long legs, tall, handsome, beautiful, this is a very good vision, we all heartbeat and entanglement I understand, in the final analysis I am just an ordinary mother.

As parents, how to rationally and dialectically choose and choose, to reduce the risk to the minimum?
This is something we have to think about and confront.

The growth and development of children must be more scientific learning and judgment, less self-cognition, after all, the growth and development of children only a few years, once missed the best treatment opportunity, we will regret for the rest of our lives.
I hope everyone can get what they need. I really hope our children can grow up healthy and tall.

June 3, 2020

Would You Support Global Sharing of COVID-19 Vaccines at Reduced Prices?

According to the Chinese embassy posted on June 3, the evening of June 1 2020, ambassador liu xiaoming attended the British sky news special programs after the outbreak of our new online interview, and former Irish President Mary Robinson, a former British foreign secretary David miliband, the American historian niall ferguson, a global influence, China's resistance to disease of epidemic, the outbreak of independent investigation, such as climate change, the situation in Hong Kong to discuss, online and answer questions from the audience.
The talk show is hosted by Sky's famous presenter, Monahan.
The TV, website, new media platform for live broadcast.
The transcript of Ambassador Liu's questions and answers is as follows:

Monahan: First of all, would you please talk about the opportunities and challenges facing our world?

Ambassador Liu: What will be the impact of the epidemic?
Will the world unite, or become more divided?
There is a lot of discussion around this issue.
I think the epidemic will bring the world together.
The epidemic once again proves that mankind lives in a global village.
As President Xi Jinping said, we should strive to build a community with a Shared future for mankind.
In my view, the epidemic once again shows that the international community should strengthen cooperation.
Facts have shown that all countries that have joined hands to fight coVID-19, supported the WHO, listened to the WHO's recommendations and supported multilateralism are under effective control.
Countries that rejected international cooperation and who recommendations paid a heavy price.
The epidemic has proved that no country, no matter how strong it is, can be immune to the virus, because the virus knows no borders and no race.

Monahan: Speaking of international investigations, the central question is: is China responsible for the crisis?
Will independent investigators be allowed to enter Chinese territory to conduct field investigations?

Ambassador Liu: Of course we welcome the international review.
But the purpose of the review is not to label any country, but to cover all countries closely associated with the epidemic.
At the World Health Assembly, we joined with 120 WHO member states in supporting the international community's review of this outbreak at the appropriate time, with a view to building lessons learned to better respond to major communicable diseases in the future.
The deliberations must be independent, exclude political interference, be science-based and scientist-led.

Monahan: Who does China think should lead the investigation?

Ambassador Liu: It should be led by the World Health Organization.
All countries should participate, especially the major ones.
I disagree with what Ferguson has just said.
His criticism of China's slow response is untrue.
Much of what Mr. Ferguson said was wrong, including the fact that many flights from Wuhan continued to fly to other countries during the lockdown.
This is wrong.
All flights were grounded after Wuhan was closed on January 23.
No flights, no trains, no external traffic.
China was the first country to report the outbreak to WHO, the first to isolate the pathogen, and the first to share the full genetic sequence of the virus with WHO and other countries.
China has wasted no time in sharing information and prevention and control experience with other countries.

Monahan: Many Chinese flights have not been grounded since the closure of Wuhan, which has caused the epidemic to spread to many countries. Isn't that a serious problem?

Ambassador Liu: Your information is totally wrong.
Wuhan has been cut off from the outside world, with no flights at all.
I am sorry to hear much of Ferguson's cold war rhetoric here. I know Ferguson but I do not know why he is so interested in cold war with China.
China is not the Soviet Union.
As a historian, you should study Chinese history carefully.
China has compiled a list of 24 lies and facts about the epidemic. I can send it to you.
Who's appreciation of China's efforts should not undermine the role of WHO.
Who is a major international organization with 194 member states.

Monahan: Is China responsible for the epidemic?
For a long time, China denied the transmission of the virus from animals to people and from person to person. You did not tell the world the truth in time.

Ambassador Liu: I have made it clear to you that China notified the WHO as soon as possible without any delay.
Novel Coronavirus is a novel virus.
In the face of unknown new viruses, we must adopt a responsible attitude, which requires serious and responsible research by scientists.
China identified the virus 11 days after the first case was detected and immediately notified the WHO, while sharing information with relevant countries.
China has nothing to hide and nothing to delay.
China's anti-epidemic record is clear and clear, which can stand the test of time and history.
I would also like to point out that just because China was the first to report the outbreak does not mean that the virus originated in China.
The origin of the virus needs to be explored by scientists.
With the development of the situation, we have seen some reports that the United States, Italy and other countries have found earlier cases than China.
Therefore, we should adopt a scientific attitude towards the problem of virus tracing.

Monahan: Will China agree to reform who?

Ambassador Liu: Of course.
The outbreak response reflects some of WHO's shortcomings, including inadequate response capacity and resources, how to respond faster and more effectively, and how to help the poorest and least able countries fight the epidemic.
Reform can come after we have overcome the epidemic.
As the epidemic continues to spread around the world, it is imperative to work in solidarity and support WHO in leading the fight against the epidemic.

Monahan: As the world's largest emitter, what steps will China take to maintain the current temporary reduction in emissions during the epidemic?

Ambassador Liu: China firmly supports the Paris Agreement and earnestly fulfills its obligations.
China has completed its carbon emission reduction plan three years ahead of schedule, and in 2018, its carbon emission intensity will be reduced by 45.8% over 2005.
China's energy consumption per unit of GDP fell 2.6 percent year on year in 2019.
China is the world's largest investor in new and renewable energy.
China is committed to tackling climate change.
China was scheduled to host the 15th Conference of the Parties to the Convention on Biological Diversity (COP15) before the end of this year.

Monahan: When does China plan to hold COP15?

Ambassador Liu: Because of the epidemic, the exact time has not been finalized.
This year was supposed to be a year of china-UK cooperation on environmental protection.
The UK has moved the 26th SESSION of the United Nations Climate Change Conference (COP26) to November next year, but we are still in close contact with our UK colleagues online to ensure the success of both conferences.

Monahan: I have a question about rebuilding trust and the novel Coronavirus vaccine competition.
We are seeing China and some countries leading the way in vaccine development.
If China develops an effective vaccine, will China be willing to share it with the world at the lowest possible price in order to rebuild trust?

Ambassador Liu: Of course.
At the World Health Assembly, President Xi Jinping solemnly declared that China's COVID-19 vaccine, when fully developed and put into use, will become a global public good, especially to make vaccines accessible and affordable to developing countries.
China is a world leader in vaccine research and development. Five of our vaccines have entered phase II clinical trials, and we are willing to share them with other countries.
China is also cooperating with scientists from Britain and the United States in research and development.

Just now, you showed a chart showing that the so-called "Reputation of China has been damaged". I do not agree with this conclusion.
It depends on where you get the information.
I can give you some information.
At the beginning of this year, The Trust Barometer, published by Edelman, the largest independent public relations company in the US, showed that 82 per cent of people in China trusted their government, the highest of any country surveyed.
In addition, according to a recent survey of 23 economies by Blackbox Research, a Singapore-based independent pollster, Chinese citizens' satisfaction with their government's response to the epidemic is the highest, with a combined score of 85%, ranking first again.

Monahan: We also want to hear from Ambassador Liu about the lack of trust in the government, especially among the younger generation.
This lack of trust can be seen on the streets of Hong Kong, "where the Chinese government cracks down on pro-democracy protesters".

Ambassador Liu: The situation in Hong Kong is far from the Chinese government cracking down on pro-democracy protesters. What is happening on the streets of Hong Kong is ongoing illegal violence.
These activities endanger China's national security.
Some violent activists stormed the Legislative Council of Hong Kong and even set fire to innocent people. If the same thing happened on the streets of London, if rioters stormed the British Parliament, how would the UK react?
Will the British government and police just sit back and let it happen?
I think any responsible government would take action.
On the other hand, one should not forget the great success of "one country, two systems" in Hong Kong since its return 23 years ago…
.

Monahan: Sorry, we're out of time.
I want to thank all the guests.
Thank you, Ambassador Liu.

June 1, 2020

Who First Identified the Human-Infecting Coronavirus?

In 1963, June Almeida was working at the Ontario cancer institute in Canada, where she was responsible for identifying and photographing virus particles using then-state-of-the-art electron microscopes.

The first person to identify a human coronavirus was a woman, June Almeida, a British virologist and expert in viral imaging.
She was born in Scotland, where her father was a bus driver, and began working as a migrant worker when she left school at the age of 16.

Later, almeida became a pioneer in the field of viral imaging.
That's why this long-forgotten name has been brought back to the world in the wake of covid-19.

Novel coronavirus is a novel strain of coronavirus that has never been found in humans before, belonging to the large family of coronaviruses.
The first human coronavirus was discovered under almeida's microscope in 1964.
She works in a laboratory at st Thomas's hospital in London.

The cold virus

Almeida was born in the northeast of Glasgow, Scotland, in 1930.
After graduating from junior high school she stopped formal schooling and took a job as a laboratory histopathological technician at Glasgow royal infirmary.

She moved to London from Scotland a few years later, married the Venezuelan artist Enriques Almeida in 1954, and soon after she had a daughter decided to move to Toronto, Canada.

As writer George Winters described, almeida mastered the art of electron microscopy at the Ontario cancer institute.

She also developed a way to image viruses using antibodies to make them polymerize.

Mr Winters told the BBC that Mr Almeida's talent was recognised by his British counterparts and he was "lured" back to work at st Thomas's hospital medical school in London in 1964.

Not to mention, Boris Johnson, the current prime minister of the UK, was treated and recovered from covid-19 in this hospital.

When almeida returned to Britain, he began working with Dr. David Tyrrell.
Dr Tyrol was running a cold virus laboratory in Salisbury, Wiltshire.

When Dr. Tirol and his team studied nasal fluid samples from volunteers, they found that a few, but not all, of the viruses associated with colds and colds could be grown in the lab.

One of the many samples, taken in 1960, came from a student at a boarding school in surrey, southern England, whose nose wash was labelled B814.

The team found that they were able to induce cold symptoms in volunteers, but were unable to do cell cultures with the virus. What was even more puzzling was that the cold virus was clearly visible in the tissues of the volunteers.

Dr Tyrol wondered if he could see the virus under an electron microscope.

They sent some samples to almeida's lab in London and asked her for help.
She saw virus particles under a microscope, a bit like a flu virus but not quite.

What she saw was actually the first human coronavirus.

Coronaviruses are a big family.
Microscopically, the virus shapes of this family have a common feature, that is, the lipid envelope is lined with widely spaced projections, whose shapes can be petal-shaped, conical, t-shaped and so on with different viruses.

Found rejected

Dr. Almeida had actually seen the particles before, winters said, when he was studying mouse hepatitis viruses and chicken bronchitis viruses.

However, the paper she submitted to a professional journal was rejected in the peer-review section, on the basis that the assessors considered the virus images she provided to be "nothing more than pictures of poorly formed influenza virus particles."

A paper based on virus particles found in the B814 sample was published in the British medical journal in 1965, and images of the virus particles she saw were published two years later in the journal of general virology.

Dr. Tyroll, Dr. Almeida and Dr. Tony Waterson, President of st. Thomas hospital, called the virus a coronavirus, according to Dr. Winters, because of the corona-like projections around the particles.

Ms. Almeida went on to continue her research at the Royal Postgraduate Medical School (now imperial college) in London, where she received her doctorate.

She ended her career at the wellcome institute in the United Kingdom, where she received several patents in the field of viral imaging.

After leaving the wellcome institute, almeida became a yoga instructor until the AIDS epidemic began in the 1980s, returning to her old career as a consultant involved in identifying and photographing HIV.

Joan almeida died in 2007 at the age of 77.

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