Development of Henoch-Schoenlein purpura in a child with idiopathic hypereosinophilia syndrome with multiple thrombotic onset: A case report

BACKGROUND The incidence of pulmonary embolism(PE) in children is low, but its mortality is high. Hypereosinophilic syndrome(HES) is a group of diseases caused by an abnormal increase in eosinophilic granulocytes resulting in multiple-organ dysfunction. The urgent event of thromboembolism in the pulmonary region provoked by eosinophils in idiopathic HES(IHES) is relatively unusual. This article reports a case of IHES with multiple PEs and left leg venous thrombosis as the first manifestation. One month later, the patient developed Henoch-Schonlein purpura(HSP), which is very rare.CASE SUMMARY We report the case of a 12-year-old boy who was admitted to the hospital with dyspnea, left leg pain, and aggravation. He had bilateral PE and left leg venous embolism with mild eosinophilia. Low-molecular-weight heparin and urokinase were given. At the same time, the interventional department was contacted about filter implantation, followed by urokinase thrombolysis. The left leg thrombus was aspirated under ultrasound guidance. He was discharged from the hospital on rivaroxaban. One month later, he developed a rash on both legs and ankle pain consistent with HSP, with severe eosinophilia and motor and sensory disturbances. The patient was diagnosed with IHES with multiple embolisms complicated by HSP after excluding other causes of the eosinophil elevation. After glucocorticoid treatment, the symptoms were relieved, but the patient later developed purpura nephritis.CONCLUSION We report a rare and life-threatening case of IHES with multiple embolisms associated with HSP.A mild elevation of eosinophils early in the disease leads to difficulties in diagnosis and delayed treatment.

Medical simulation-based education improves medicos' clinical skills

Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos＇ clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.

Antiphospholipid Antibody and Antiphospholipid Syndrome

Antiphospholipid antibodies(APA)APA is a big category for all kinds of negative charge phospholipid or lecithin- a protein complex autoantibodies or the same antibody,through its recognition of antigen(target protein) different,and

Efficacy analysis of inferior oblique muscle belly transposition for small-angle asymmetric superior oblique palsy

Asymmetric superior oblique palsy(SOP)is a complicated,non-comitant type of strabismus.Patients usually present with small-angle hypertropia in the affected eyes,accompanied by inferior oblique muscle overaction(IOOA).[1]Compensatory head posture and asymmetric development of the face are typically observed in congenital SOP,while diplopia is more common in an acquired SOP.[2]Prism glasses can improve diplopia and vertical deviation in the primary position,but they are not so successful at correcting non-comitant paralytic strabismus.In addition,vertical strabismus and compensatory head posture will return after the prism glasses are removed,wearing prism glasses will lower the vision of children prominently.Surgery like an inferior oblique muscle(IO)weakening procedure is often required eventually in those patients.However,conventional procedures for IO weakening may cause overcorrection and/or secondary A pattern in patients who have mild to moderate IOOA together with small-angle asymmetric SOP,posing a risk to its safety.[3]In the study by Caldeira,[4]21%of the patients with mild to moderate IOOA developed A pattern following the surgery.Therefore,it remains a clinical challenge to select the most appropriate type of surgery for the treatment of small-angle asymmetric SOP.Inferior oblique muscle belly transposition(IOMBT),[5]a new IO weakening procedure introduced to our practice lately,has shown positive results in treating small-angle asymmetric SOP as well as a lower risk of complications such as overcorrection and secondary A pattern.In this study,we evaluated the efficacy and safety of the IOMBT procedure for the treatment of small-angle asymmetric SOP.

Paclitaxel and cisplatin with or without cetuximab in metastatic esophageal squamous cell carcinoma:a randomized,multicenter phase II trial

Lack of effective targeted therapy in metastatic esophageal squamous cell carcinoma(ESCC)underscores the urgent need for identifying new treatment approaches for this challenging disease.We sought to assess the addition of cetuximab to paclitaxel-cisplatin chemotherapy for first-line treatment in patients with metastatic ESCC.In this randomized,multicenter,open-label,phase II clinical trial,patients were randomized to receive paclitaxel-cisplatin(TP)(paclitaxel[175 mg/m^(2) intravenously(i.v.)on day 1 of every 3-week cycle]and cisplatin[75 mg/m^(2) i.v.on day 1 of every 3-week cycle])and TP plus cetuximab(CTP)(cetuximab,400 mg/m^(2) i.v.on day 1 of week 1,followed by 250 mg/m^(2) weekly).