Hourglass-like constriction of the anterior interosseous nerve in the left forearm:A case report

BACKGROUND Hourglass-like constriction neuropathy is a rare neurological disorder.The main clinical manifestation is peripheral nerve injury with no apparent cause,and the pathomorphological change is an unexplained narrowing of the diseased nerve.The diagnosis and treatment of the disease are challenging and there is no accepted diagnostic or therapeutic approach.CASE SUMMARY This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.CONCLUSION Hourglass-like constriction neuropathy is a rare disorder.With the development of medical technology,more examinations are now available for diagnosis.This case aims to highlight the rare manifestations of Hourglass-like constriction neuropathy and provides a reference for enriching the clinical diagnosis and treatment experience.

Does strict environmental regulation enhance the global value chains position of China's industrial sector?

Given the vital importance of global value chains(GVCs)position for a country's international competitiveness,this paper tries to investigate the impacts of environmental regulation on the GVCs position of China's industrial sector.Using the latest value-added decomposition method,we first measure the GVCs position of China's industrial sector from 2003 to 2014.Subsequently,both two-stage least squares(2 SLS)method with panel data and mediating effect model are employed to empirically examine the effects of environmental regulation on China's position in GVCs.The results indicate that environmental regulation has significantly upgraded the GVCs position of China's industrial sector,and the effect is more evident for the sub-sectors with originally lower GVCs position.The mediation effect test shows that increasing R&D investment is an important channel through which environmental regulation affects the GVCs position of China's industrial sector,which verifies the existence of the Porter hypothesis.Further analysis finds that the enhancement of GVCs position of China's industrial sector caused by environmental regulation is mainly achieved through reducing the backward GVCs position.

Myeloid sarcoma with ulnar nerve entrapment:A case report

BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.

Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.

Prehospital Identification of Stroke Subtypes in Chinese Rural Areas

Background： Differentiating intracerebral hemorrhage （ICH） from cerebral infarction as early as possible is vital tbr the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes. Methods： From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography （CT） or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes＇ discriminant model was applied to discriminate stroke subtypes. Results： Among the 1989 patients, 797,689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure _〉180 mmHg, and age 〈65 years were more typical of ICH. For noncomatose stroke patients, Bayes＇ discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%. Conclusions： The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.

Heterogeneous impacts of GVCs participation on CO_(2) intensity:Evidence from developed and developing countries/regions

The deepening of global value chains(GVCs)has made remarkable impacts on the environmental outcomes of all countries/regions.What are the differences in environmental burden undertaken by countries/regions at different stages of economic development are a question worthy inquiry.This study compares the impacts of GVCs participation degree on CO_(2) intensity between developed and developing countries/regions.Using panel data of 19 manufacturing industries in 43 countries/regions over the period of 2000-2014,it is discovered that the deeper participation in GVCs of developed countries/regions significantly reduces their CO_(2) intensity,while the more participation in GVCs of developing countries/regions significantly increases their CO_(2) intensity.Additionally,the quantile regression results reveal that the reduction of CO_(2) intensity is increasing for industries with higher initial CO_(2) intensity for developed countries/regions,whereas for developing countries/regions,only industries with initial low CO_(2) intensity experience significant increases in CO_(2) intensity.We further analyzed the effect of GVCs participation degree on CO_(2) intensity for high-tech and low-tech industries and discovered that the effect is only significant in low-tech industries.These findings provide empirical evidence for the pollution haven hypothesis and offer enlightenment to formulate future trade and environmental policies.