Unifocal progressed to multifocal renal artery fibromuscular dysplasia

Catheter angiography revealed distal unifocal stenosis of the renal artery progressed to a middle typical string of beads appearance in a 24-year-old Chinese woman diagnosed with fibromuscular dysplasia

The Peony Pavilion as a picture of sexual individuation

The Peony Pavilion is a story central to Chinese gender identity. It vividly portrays a story of the path of sexual individuation of a Chinese woman. In comparison to female images in Western stories, Chinese women are the active ones in their intimate relationships with men. They have been oppressed for many years because they are recognised as the subject of desire and as having reflexive aggression. However, with enough love, a girl dares to separate from her natal family, to fight against the patriarchal system, and to be herself. Identifying with the father’s aggression can facilitate her in this process.

A Chinese Patient with Spastic Paraplegia Type 4 with a De Novo Mutation in the SPAST Gene

Background. Spastic paraplegia type 4 (SPG4) is the most common type of hereditary spastic paraplegia (HSP) caused by mutations in the SPAST gene. Case Presentation. We report the case of a 27-year-old pregnant Chinese woman with HSP in whom we identified a missense mutation in the SPAST gene (c.1496G>A, p.Arg499His) and a nonsense mutation in the NEFH gene (c.289G>T, p.Glu97 ∗ ) via whole-exome sequencing; this finding corroborated that of Sanger sequencing. The patient exhibited the pure SPG4 phenotype with onset during childhood. The SPAST mutation was absent in the parents and paternal relatives. However, the NEFH mutation was identified in five people with no clinical phenotype. Based on theoretical conjecture and the family gene segregation information, we concluded that the SPAST mutation, but not the NEFH mutation, accounted for the proband’s phenotype. Eventually, the woman gave birth to a healthy baby girl with the NEFH mutation. Conclusion. In this report, we identified a missense mutation in the SPAST gene (p.Arg499His) in a 27-year-old pregnant Chinese woman with HSP. We believe that this study expands the knowledge about the clinical parameters and mutation spectrum of SPG4.

Development of Graves' Disease After SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination.Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: “COVID,” “vaccine,” “thyroid,” “thyroiditis,” and “Graves.”Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines.Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.

Endometriosis of the sciatic nerve masquerading as lumbar spondylosis in a 40-year-old Chinese woman

A 40-year-old Chinese woman presented with a 4-year history of lower back pain and left lower leg sciatica. The patient had previously tried different modalities of treatments, including massage, acupuncture, ultrasound, alternative Bowen therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), all of which only provided temporary relief. On presentation to a tertiary hospital, careful and comprehensive history taking found that the sciatica pattern of pain always coincided with menstruation. An MRI identified a thickened left sciatic nerve, with surgery confirming sciatic nerve endometriosis. The case highlights the importance of comprehensive history taking in accurately diagnosing a rare aetiology of sciatica with subsequent prompt surgical intervention to avoid severe disability as well as follow-up treatment to prevent recurrence.

Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report

Background: Acute hypertensive retinochoroidopathy is a rare, severe ocular disease, characterized by retinal and choroidal ischaemia. Untreated cases are associated with high mortality and poor visual outcomes. Patients subjected to treatment with the anti-neoplasic drug apatinib may trigger this disease. The purpose of this article is to describe in detail an acute hypertensive retinochoroidopathy in a young Chinese woman treated with apatinib.Case Presentation: A 40-year-old young Chinese woman presented a sudden but painless reduction of visual acuity in both eyes. She was previously diagnosed with gastric cancer and metastatic ovarian adenocarcinoma. The treatment consisted radical gastrectomy, transabdominal hysterectomy, bilateral adnexectomy, and 250 mg oral apatinib per day. After 58 days of apatinib administration, the patient immediately sought consult for a sudden decrease in vision. Her blood pressure was 208/136 mmHg and, based on the clinical manifestations, the patient was diagnosed with acute hypertensive retinochoroidopathy.Conclusions: This is the first case report of an apatinib-related acute hypertensive retinochoroidopathy diagnosed using fundal photograph, fundus fluorescein angiography, and spectral-domain optical coherence tomography simultaneously. It is crucial to develop a suitable strategy for management and prevention of this adverse event.

The Bulky Dermoid Cyst of the Floor of the Mouth

Bulky dermoid cysts of the floor of the mouth are very rare and may induce functional disorder. We present a 68-year-old Chinese woman who presented a painless swelling in right mandibular. Physical examination revealed a painless, soft, poor mobility, doughlike mass swelling which was reached to the floor of the mouth, and MRI showed a circumscribed mass of about 20.0×10.0×12.0 cm size. After complete excision of the cyst through an extraoral approach, histology diagnosed dermoid cyst. Dermoid cyst is uncommon found in the floor of the mouth, where there is a soft, painless, associated dyspnea, dysphagia and dysarthria. Imaging may assist diagnosis. Definitive diagnosis is founded on the histology specimen. According to the location and size of the cyst on each occasion, enucleation via intraoral or extraoral approach will be chosen treatment for cyst in the floor of the mouth. Although malignant degeneration of dermoid cyst of the floor of mouth is extremely rare, there are also such a situation reports. Thus, it is important to remove a cyst before the opportunity for malignancy.