Severe Pulmonary Embolism,Thrombosis of Lower Extremity,Unexpected Mild Renal Disorder in MPO-ANCA Associated Vasculitis:A Case Report

Myeloperoxidase antineutrophil cytoplasmic antibody(MPO-ANCA)associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome,especially prominent acute renal failure.A 65-year-old woman was admitted with progressive dyspnoea for six months and fever,sputum with blood,pain of the lower extremities and intermittent claudication for two days,indicating multiple organ involvement(respiratory system,blood vessels).The renal involvement was relatively mild,presenting with microscopic haematuria.The chest computed tomography demonstrated multiple pulmonary embolisms.Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis.Exclusion of other diseases that can cause multiple organ damage and thrombosis,the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis.The patient’s physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.

Validation of proposed diagnostic criteria for allergic bronchopulmonary aspergillosis

To the Editor:Allergic bronchopulmonary aspergillosis(ABPA)is an allergic lung disease caused by hypersensitivity to antigens from Aspergillus,and it most commonly occurs in patients with asthma or cysticbrosis.[1]The main clinical characteristics of the disease are those related to elevated serum immunoglubulin(Ig)E level,positive Aspergillus fumigatus(A.fumigatus)specic IgE/IgG,repeated pulmonary inltration,and bronchiectasis.However,due to the lack of unied diagnostic criteria and screening methods,ABPA is always underdiagnosed.In 2021,new diagnostic criteria were proposed for allergic bronchopulmonary mycosis(ABPM)in the Japanese population.

Special Chiral C_(2)-Symmetric endo-Biarylnorbornane: Synthesis and Structure Illustration

A highly efficient and practical synthesis for strained special scaffold of chiral endo-biarylnorbornane starting from available norbornadione was achieved with direct stereoselective dehydroxylation of tertiary alcohol as the key step,and the structure was illustrated by X-ray structural analysis.

Hand surgery in a new“hand-brain” era:change the hand,rebuild the brain

Amputated hand,and paralyzed hand,are diseases not on the conventional list of the hand surgery world,but now have gradually become the new direction for hand surgeons.A good example is the advancements in treating amputations after traumatic injury of the upper limb.Targeted muscle reinnervation combined with a highly functional bionic arm can greatly compensate for the missing part of the amputated arm[1],which in general satisfies the need for strength and dexterity in daily life.According to the classic cortical homunculus first drawn by Penfield,the hand area occupied nearly-one-third of the sensorimotor cortex[2].Thus,interventions with the hands enable the modulation of brain function,providing a solution for brain disorders through skillful utilization of brain plasticity.With the recent advancements in neuroscience and biomedical engineering technology,hand surgeons find themselves entering an era with a bigger performance stage than ever before.For paralyzed hand,the most common cause is central neurological diseases such as stroke or cerebral palsy,or paraplegia.Although it is more challenging since surgeons should balance spasticity and motor function at the same time,efforts have been made by hand surgeons around the world,such as hyper selective neurectomy,tendon lengthening or transfer to reduce the spasticity and reconstruct the motor function[3].Considering the fact that the number of patients with paralyzed hands is over 10 million,which far exceeds the traditional nerve injury entity,this area is the potential further direction of hand surgery.In this article,we will discuss the opportunities and pitfalls in the combination of hand surgery techniques and brain-computer-interface(BCI)in treating paralyzed hands from the perspective of hand surgery development.