Bullous pemphigoid associated with acquired hemophilia A: A case report

BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.

Adult localized Langerhans cell histiocytosis:A case report

BACKGROUND Langerhans cell histiocytosis(LCH)is a rare clonal proliferative disease of Langerhans cells with unknown pathogenesis.An increasing number of clinicians recognize that LCH has a wide clinical spectrum and a highly varied course.Adults rarely develop LCH.Here,we report a case of adult localized LCH.CASE SUMMARY A 32-year-old woman presented with plaques and ulcers on the vulva and crissum,accompanied by pain that persisted for more than one year.Physical examination revealed a red-infiltrating plaque with ulcerations and exudates in the vulva and crissum.Pathological examination revealed a diffuse infiltration of lymphocytes,eosinophilic granulocytes,and histiocytoid cells in the superficial dermis.Proliferative histiocytoid cells showed mild atypia,partly with kidneyshaped nuclei.Immunohistochemical examination showed that the histiocytoid cells were positive for S100 protein and CD1 and weakly positive for CD68(20%+),with a Ki-67 index of 30%.Laboratory tests did not reveal any other systemic damage.The patient was diagnosed with adult localized LCH and was prescribed oral prednisone(20 mg)once daily.The skin lesions gradually improved and are still being followed-up.CONCLUSION Adult localized LCH is rare and must be differentiated from other common conditions.

Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis:A propensity score analysis

BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.

Recent advances in carbon-supported non-precious metal singleatom catalysts for energy conversion electrocatalysis

Non-precious metal single-atom catalysts(NPM-SACs)with unique electronic structures and coordination environments have gained much attention in electrocatalysis owing to their low cost,high atomic utilization,and high performance.NPM-SACs on carbon support(NPM-SACs/CS)are promising because of the carbon substrate with a large surface area,excellent electrical conductivity,and high chemical stability.This review provides an overview of recent developments in NPM-SACs/CS for the electrocatalytic field.First,the state-of-the-art synthesis methods and advanced characterization techniques of NPM-SACs/CS are discussed in detail.Then,the structural adjustment strategy of NPM-SACs/CS for optimizing electrocatalytic performance is introduced concisely.Furthermore,we provide a comprehensive summary of recent advances in developing NPM-SACs/CS for important electrochemical reactions,including carbon dioxide reduction reaction,hydrogen evolution reaction,oxygen evolution reaction,oxygen reduction reaction,and nitrogen reduction reaction.In the end,the existing challenges and future opportunities of NPM-SACs/CS in the electrocatalytic field are highlighted.

Effects of L-arginine and N~ω-nitro-L-arginine methylester on learning and memory and α7 nAChR expression in the prefrontal cortex and hippocampus of rats

Nitric oxide （NO） is a novel type of neurotransmitter that is closely associated with synaptic plasticity, learning and memory. In the present study, we assessed the effects of Larginine and NnitroL arginine methylester （LNAME, a nitric oxide synthase inhibitor） on learning and memory. Rats were assigned to three groups receiving intracerebroventricular injections of LArg （the NO precursor）, LNAME, or 0.9% NaCI （control）, once daily for seven con secutive days. Twelve hours after the last injection, they underwent an electric shockpaired Y maze test. Twentyfour hours later, the rats＇ memory of the safe illuminated arm was tested. After that, the levels of NO and a7 nicotinic acetylcholine receptor （a7 nAChR） in the prefrontal cortex and hippocampus were assessed using an NO assay kit, and immunohistochemistry and Western blots, respectively. We found that, compared to controls, LArgtreated rats received fewer foot shocks and made fewer errors to reach the learning criterion, and made fewer errors during the memorytesting session. In contrast, LNAMEtreated rats received more foot shocks and made more errors than controls to reach the learning criterion, and made more errors during the memorytesting session. In parallel, NO content in the prefrontal cortex and hippocampus was higher in LArgtreated rats and lower inLNAME rats, compared to controls. Similarly, （]7 nAChR immunoreactivity and protein expression in the prefrontal cortex and hippocampus were higher in LArgtreated rats and lower in LNAME rats, compared to controls. These results suggest that the modulation of NO content in the brain correlates with a7 nAChR distribution and expression in the prefrontal cortex and hippocampus, as well as with learning and memory performance in the Ymaze.

Ten Basic Principles about Critical Ultrasonography： Critical Care Practitioners Need to Know

With the noninvasive, convenient, and unique value in tile quick diagnosis and dynamic monitoring during the course of treatment, critical ultrasonography has been widely used in critical care medicine, regarded as the ＂visual stethoscope＂ and applied in medical education and training system. Based on years of experience in the application and promotion of critical ultrasonography, the authors of this study suggested that a proper understanding of critical ultrasonography is of most importance, and a consistent quality control system is required to minimize misdiagnosis,

Controlled growth of complex polar oxide films with atomically precise molecular beam epitaxy

At heterointerfaces between complex oxides with polar discontinuity, the instability-induced electric field may drive electron redistribution, causing a dramatic change in the interracial charge density. This results in the emergence of a rich diversity of exotic physical phenomena in these quasi-two-dimensional systems, which can be further tuned by an external field. To develop novel multifunctional electronic devices, it is essential to control the growth of polar oxide films and heterointerfaces with atomic preci- sion. In this article, we review recent progress in control techniques for oxide film growth by molecular beam epitaxy （MBE）. We emphasize the importance of tuning the microscopic surface structures of polar films for developing precise growth control techniques. Taking the polar SrTiO3 （110） and （111） surfaces as examples, we show that, by keeping the surface reconstructed throughout MBE growth, high-quality layer-by-layer homoepitaxy can be realized. Because the stability of different reconstruc- tions is determined by the surface cation concentration, the growth rate from the Sr/Ti evaporation source can be monitored in real time. A precise, automated control method is established by which insulating homoepitaxial SrTiO3 （110） and （111） films can be obtained on doped metallic substrates. The films show atomically well-defined surfaces and high dielectric performance, which allows the surface carrier concentration to be tuned in the range of -1013/cm2. By applying the knowledge of microstructures from fundamental surface physics to film growth techniques, new opportunities are provided for material science and related research.