Chinese Lady Research Articles

#1273 Rapidly progressive glomerulonephritis with anti-neutrophil cytoplasmic antibodies, in a patient on golimumab

Abstract Background 73-year-old Chinese lady presented with fever, gross hematuria, and dysuria of 1-week duration. She has seronegative arthritis and was treated with human anti-tumor necrosis factor alpha monoclonal antibody (TNF-alpha inhibitor), golimumab injection 50 mg monthly, as she had previous adverse reaction with sulfasalazine and methotrexate. She suffered from severe osteoporosis and was treated with oral alendronic acid. At presentation, her blood pressure was 172/76 mmHg and pulse rate 100 beats per minute. The highest recorded temperature was 38.1 degrees Celsius. Clinical examination was unremarkable. She was diagnosed with rapidly progressive glomerulonephritis (RPGN). Creatinine at presentation was 252 µmol/L, estimated glomerular filtration rate (eGFR) 16 mL/min/1.73 m2. Two months ago, her creatinine was 68 µmol/L, eGFR 66 mL/min/1.73 m2. Urinalysis showed dysmorphic red blood cells of more than 2250 per high power field, few white blood cells, and no epithelial cells. Urine protein/creatine ratio (UPCR) was 2.3 g/g and serum albumin level was 30 g/L. ANA was borderline raised at 1:160 titer with homogeneous pattern. Anti-double stranded DNA (anti-dsDNA) was indeterminate at 29.34 IU. Anti-myeloperoxidase (MPO) antibody was positive at 162 RU/mL (Normal < 20 RU/mL). Anti-proteinase-3 (PR3) antibody was negative. Serum complement levels (C3 and C4) were normal. Screening for hepatitis B, hepatitis C, and HIV was negative. Ultrasound imaging of the kidneys showed raised renal echoes and resistive index. Percutaneous kidney biopsy was performed. On light microscopy, 19 glomeruli were seen. Some displayed segmental increase in mesangial cells and expansion of mesangial matrix. 4 glomeruli showed cellular crescents (Fig. 1). Immunofluorescence showed dominant 2+ staining for Immunoglobulin A (IgA) in the mesangium and electron microscopy revealed electron dense deposits in the mesangial and para-mesangial region. An occasional tubuloreticular structure was found. Diagnosis of IgA nephropathy was made and Oxford classification was M0 E1 S0 T0 C1. Results Our patient presented with rapidly progressive glomerulonephritis (RPGN) with positive MPO antibody, as well as ANA and anti-dsDNA at indeterminate levels. TNF-alpha inhibitors may lead to autoantibody formation and kidney biopsy was the key in clinching the diagnosis for our patient. Diagnosis of IgA nephropathy was made on the basis of dominant mesangial IgA on immunofluorescence and ultrastructural electron dense deposits within the mesangial and para-mesangial area. To our best knowledge, there has been only one case of IgA nephropathy reported with golimumab that occurred after 3 years and with mild albuminuria and no decline in renal function. Golimumab was promptly discontinued for our patient and she was inducted with pulsed methylprednisolone and high dose oral prednisolone 1 mg/kg/day. As she had history of severe osteoporosis, oral mycophenolate mofetil at 750 mg twice a day was commenced as steroid sparing agent. Prednisolone dose was then tapered to 0.5 mg/kg/day. She achieved full clinical remission after 3 months of immunosuppressive therapy. MPO antibody level decreased to normal after 5 months. Arthritis activity remained quiescent and she was maintained on low dose prednisolone. Conclusion We report a case of IgA nephropathy with crescents associated with golimumab. Treatment was successful with withdrawal of drug, oral prednisolone and mycophenolate mofetil.

OA16 A case of anti-MDA5 dermatomyositis: the challenge of atypical skin manifestations

Abstract Introduction Anti-MDA5 dermatomyositis (DM) is a rare systemic autoimmune condition associated with clinically amyopathic DM and rapidly progressive interstitial lung disease (RP-ILD). In addition to the classical DM dermatological manifestations, anti-MDA5 DM is associated with unique skin features including cutaneous ulceration, eyelid oedema, palmar papules and mechanic’s hands. An awareness of these features is essential for prompt diagnosis and management. Here we present a challenging case of anti-MDA5 DM with unusual skin manifestations, complicated by RP-ILD. Case description A 60-year-old Chinese lady with no past medical history presented to ophthalmology with oedema to her left eye and was diagnosed with pre-septal cellulitis. One week later, she presented with low-grade fevers, fatigue, and palpitations on exertion. Systems review and blood tests were unremarkable, and she was discharged with outpatient cardiac follow-up. One month later, she presented to the A&E with ongoing fatigue, 10kg unintentional weight loss, and reduced mobility. She was cachectic with ulcerating skin lesions on her shoulders and hips (thought to be pressure sores). Initial results showed a normocytic anaemia, deranged electrolytes (likely related to poor oral intake) and a raised troponin (likely rate-related). A CT scan of her chest, abdomen and pelvis showed no evidence of malignancy, but demonstrated patches of consolidation in both lungs, with nodularity and ground-glass changes; a differential diagnosis included inflammation, infection and heart failure. She developed pyrexia and mild hypoxia during admission, and was empirically treated for bilateral pneumonia. Five days after admission, fasciculations in her upper limbs and tongue prompted a neurology review. Nerve conduction studies demonstrated myopathic changes. An elevated creatine kinase (CK) and an MRI lower limbs confirming diffuse oedema, further supported a myositis diagnosis. Concurrently, she was noted to have mechanic’s hands and a lesion, potentially representing a Gottron’s papule, was biopsied revealing features suggestive of an immune vasculitis. Fifteen days after admission, she developed severe type-1 respiratory failure requiring transfer to intensive care. Repeat CT imaging showed worsening bilateral consolidation and ground-glass changes, with moderate pleural effusions. Her rapidly progressively respiratory failure in the context of likely DM prompted a suspicion of anti-MDA5 DM, and urgent referral to a tertiary centre for extra-corporeal membrane oxygenation (ECMO) and aggressive immunosuppression. Unfortunately, she died three weeks later. Autoantibody testing confirmed positive anti-MDA5 and Ro52 antibodies. Discussion This case presented a number of diagnostic challenges. Firstly, the patient’s initial presentation was not typical for classical DM. On admission, she had normal power in her upper and lower limbs and a normal CK. Furthermore, her skin manifestations were atypical and misdiagnosed as more common conditions. The skin ulceration on her shoulders and hips was attributed to pressure sores, and her eyelid oedema was thought to be secondary to pre-septal cellulitis. Throughout her inpatient stay, more typical features of DM were noted. These included a Gottron’s papule, mechanics hands and a proximal myopathy. When these features were detected, a diagnosis of DM was suspected, and the relevant investigations performed. The second diagnostic challenge related to the diagnosis of RP-ILD. When the patients respiratory symptoms deteriorated, she was initially managed for pneumonia and fluid overload. After dermatology, rheumatology and respiratory review, a diagnosis of anti-MDA5 RP-ILD was suspected, and appropriate management was initiated. Unfortunately, due to the aggressive nature of her underling lung disease, she continued to deteriorate and died. This case highlights the significant mortality associated with this condition, and the importance of prompt recognition for optimisation of treatment. Key learning points The hallmark cutaneous features of DM occur with a similar prevalence in patients with anti-MDA-5 DM. These include Gottron’s papules, a heliotrope rash, the Shawl sign, V sign and mechanics hands. Anti-MDA5 DM is also associated with specific dermatological manifestations including deep and painful skin ulceration, palmar papules and eyelid oedema. An awareness of these cutaneous features is important to allow earlier consideration of the diagnosis of anti-MDA5 DM. Anti-MDA5 DM is commonly associated with clinically amyopathic or hypomyopathic dermatomyositis. Cohort studies estimate that between 23% − 100% of patients with clinically amyopathic DM test positive for anti-MDA-5 antibodies. Therefore, there should be a high index of suspicion for anti-MDA5 DM in patients with amyopathic presentations. Anti-MDA-5 dermatomyositis is associated with RP-ILD and a poor prognosis. Observational studies have estimated that ILD occurs in 82 − 100% of patients with anti-MDA-5 DM in East Asian populations. RP-ILD has been estimated to occur in 39-100% of these patients, and is associated with an extremely poor prognosis (Nombel et al, 2021). Observational studies suggest that CRP, ferritin and MDA-5 antibody titres correlate with mortality rates and treatment response. Further work is needed to identify biomarkers predictive of the development of RP-ILD. A multidisciplinary team approach is vital in order to optimise the management of these patients, who can present to a broad range of speciality teams.

Materializing Habit to Make Visible

This article investigates how the performance of Lloyd Suh’s The Chinese Lady foregrounds the matter of visibility as a construct shaped by habitual patterns of perception, which in turn frames cultural bodies in ways that are marginalized, obscured and often misunderstood. Through the lens of habit, this play reveals how entrenched ways of seeing contribute to ‘habitual suffering’, the phenomenon where repeated exposure to simplified cultural representations leads to a diminished grasp of individuals’ multi-layered identities. The play’s interrogation of the audience’s passive consumption of the protagonist, Afong Moy, as a spectacle within a museum setting, resonates with Judith Butler’s theory of ‘frames’. Drawing on this conceptual framework, this article dissects the mechanisms through which habitual perspectives are formed and perpetuated. In doing so, it questions the spectators’ complicity in these processes and explores the potential for performing arts to disrupt and reconfigure the habitual gaze. By examining the paradoxical role of habit that simultaneously provides comfort through routinization and dulls sensory acuity, the article elaborates on how visibility is materially affected by the repetitive nature of human behaviour. It further suggests that the performing space can serve as a concrete medium to manifest, challenge and alter the ingrained way audiences engage with and interpret otherness, promoting a more nuanced and empathetic approach to cross-cultural encounters.

Differentiating gout and calcium pyrophosphate deposition disease: Role of imaging

75-year-old Chinese lady with diabetes mellitus, hypertension and history of bilateral knee arthroplasty was diagnosed with gouty arthritis for 14 years

The Chinese Lady by Lloyd Suh

Reviewed by: The Chinese Ladyby Lloyd Suh Dohyun Gracia Shin THE CHINESE LADY. By Lloyd Suh. Directed by Ralph B. Peña. Barrington Stage Company and Ma-Yi Theater Company, Public Theater, New York City. 02 27, 2022. When Atung (Daniel K. Isaac), the translator and manservant of "the Chinese lady," opened up a green cargo box labeled "China Shipping," the audience was introduced to Afong Moy (Shannon Tyo), who is thought to be the first Chinese woman ever to come to the United States. She greeted the audience: "Hello. My name is Afong Moy. It is the year 1834. I am fourteen years old, and newly arrived in America. … Thank you for coming to see me." Afong Moy sat as an exhibition on the boxlike stage adorned with Chinese furniture, luxury goods, and flowers. Every detail of Chinoiserie in the box, including Afong Moy herself in a porcelain-patterned Chinese dress (by costume designer Linda Cho), was imagined to be "representative of China." However, The Chinese Ladyby the Barrington Stage Company and Ma-Yi Theater Company revealed that the US fantasy of China fabricated with transported Oriental luxuries has a hollow echo. Like lifeless, artificial flower petals on the stage's walls, the room was unlike any room in China, and Afong Moy was "unlike any lady to ever live." On the stage, which was made to look like a miniature box, she repeated a routine for the audience who paid to see her performance. When Atung opened a curtain, she introduced herself, walked one revolution around the room with her bound feet, ate Chinese cuisine with chopsticks, and demonstrated the tea ceremony while Atung sold Chinese luxury goods to the audience in the corner. Regardless of her taste or will, she was expected to follow a routine designed to facilitate a white audience's "education and entertainment" (or obsession with "commercial Orientalism"—to borrow John Kuo Wei Tchen's term inspired by Edward Said's "Orientalism"). In this mechanical repetition, The Chinese Ladyas directed by Ralph B. Peña delineated Afong Moy and Atung's unfulfilled desires through their conversations, which landed ironically each time they reprised the routine. The play's author, Lloyd Suh, embedded changes in the eerie routine that twisted stereotypical representations of Asian Americans. Afong Moy, who had been fetishized and consumed as a stereotypical Asian woman, was transformed to play in between an object of desire, subject to the gaze of others, and a desiring subject gazing back at US culture. Shannon Tyo delivered an Afong Moy brimming with speculation on US and Chinese culture, chattering away in a doll-like voice with grand theatrical gestures. Afong Moy's seemingly shallow speechifying, equating corsets with bound feet and so on, ironically revealed her counter-gaze on white voyeurism. Tyo's performance highlighted a stark contrast between young, naïve, hopeful Afong Moy and mature, disillusioned, ghost-like Afong Moy, disclosing the xenophobia and racism that obfuscated any trace of Afong Moy's later life in the United States. The Chinese Ladyfurther added a touch to Atung—the stereotypical trope of an "emasculated Asian male"—by focusing on his profession as a translator. Ventriloquizing white men's desire, Atung sold Chinese luxury goods, tickets to Afong Moy's performance, and the exoticism of Chinese culture itself. While Afong Moy showed a strong desire to bridge China and the United States by putting herself on display as an object of desire, Isaac's performance captured Atung's suppressed desire in his gentle smile, comical presentation, and slow locution, which did not clearly show his inner thoughts and feelings—these later exploding in his monologue on Atung's dream, the vividly sexual portrayal of his desire to be recognized. The most notable thing about Atung in The Chinese Ladyat the Public was that the production highlighted Atung's position as a translator. In the process of translation, Atung saw himself "interpreting" others' words with his point of view instead of "directly recreating" the white view. Before reenacting a reimagined conversation between Afong Moy and US President Andrew Jackson, he said that "we can only simulate the past, not in pursuit of...

Case report on Acute Cardiopulmonary failure with Pneumonitis with Pickwickian syndrome

INTRODUCTION: The inability of the heart to supply enough blood flow to the body's metabolic tissues is known as heart failure (H.F.). A patient's tolerance for physical activity is described by the N.Y.H.A. Classification of H.F., updated in 1994 to include objective assessments of heart function and disease. The phrase "cardiopulmonary disease" is used in medicine to refer to various dangerous diseases that affect the heart and lungs. Cardiovascular Disease (CVD) and Chronic Obstructive Pulmonary Disease (C.O.P.D.) are the two main cardiopulmonary conditions caused by cigarette use (C.O.P.D.). A severe respiratory infection brings on the lung condition known as pneumonia. The tiny sacs called alveoli that make up a healthy person's lungs are filled with air as they breathe. Pneumonia causes the alveoli to fill with pus and fluid, making breathing challenging and limiting oxygen intake. A metabolic syndrome is a group of risk factors associated with cardiovascular disease morbidity and mortality. It is often referred to as Syndrome X. (CVD). Despite being widespread, it has not received enough attention and occasionally goes unnoticed. As primary care practitioners, we must keep an eye out for these people so that early identification, intervention, and prevention can be put into practice.A Chinese lady with metabolic syndrome is described in the following paragraphs. Present complaint and investigation: on March 28, 2022, a 62-year-old female was hospitalized at A.V.B.R. Hospital with breathing difficulty, lower limb swelling, chest pain, mucus in the throat and lungs, loss of appetite, nausea, and vomiting. Twelve days have passed. Investigation: Haemoglobin is decreased by 10.7gm, WBC count 11,000 per microliter, Total R.B.C. count increased 5.84 million /cell, M.C.H. level Decreased 70fl, MCH IS DECREASE 22.8 pico-gm. Therefore CT report should be interpreted in correlation with clinical &pathological findings. PAST HISTORY: he was admitted eight days before outside the hospital for the same complaints on 26/02/2022. Pneumonia one year back for which she symptoms in 2000 for fibroid he took treatment. After the physical examination and investigation, diagnosed RESPIRATORY ACIDOSIS WITH OBSTRUCTIVE SLEEP APNEA WITH HYPERTENSION. Conclusion: He responded well to all medication and doctor care and made a good recovery.

Raiding the Bull in a China Shop

This essay explores the ways that installation facilitates thinking through the conditions of possibility for the exhibition of eighteenth- and nineteenth-century Asian objects within the context of American homes and museums. The racialization and deracination of collected Asian objects and excluded Asian people, as explored in Triple Canopy and CFGNY’s (Concept Foreign Garments New York’s) installations for the Rhode Island School of Design Museum’s Raid the Icebox Now and Lloyd Suh’s play The Chinese Lady invites a reexamination of subjectivity and objecthood, along with attendant assumptions about agency. By turning to “subjectness” discourse and Asiancy, following the work of Kandice Chuh and Tina Chen alongside performance studies methodology, the project rethinks the histories and possibilities for objects and subjects of Asian Americanist critique.

1927년 하이퐁(Hải Phòng) 화교 배척 사건의 발단, 전개, 대응의 제 양상 - 자료 《民國十六年 八一七越南海防慘殺華僑案紀》를 중심으로 -

This article is to review Anti-Chinese riots of Haiphong(ACRH) with a ‘Min-Guo Shi-liu-Nian Ba-yi-qi Yue-nan Hai-phang Can-sha Hua-qiao An-ji’[民國十六年 八一七越南海防慘殺華僑案紀] which was published by Guangzhou Office of Chinese Kuomintang’s Central Committee in 1928. The results of these review are as follows. Firstly, ACRH began from a quarrel between a Chinese lady and a Vietnamese lady at a city water fountain near the Haiphong Chinatown in August 17, 1927. The quarrel spread to two people’s local residents, neighbors, and passers-by. Overseas Chinese community in Haiphong and Nanking Nationalist Government argued that French Colonial Government of Indochina(FCGI) hesitated to calm down the dispute early not to get worse matters. whereas FCGI did not agree. In addition, Overseas Chinese community in Haiphong regarded ACRH as a Vietnamese unilateral violence on Chinese, while FCGI viewed ACRH as damages caused by clashes between Vietnamese and Chinese. According to the Chinese material, 12 Chinese were killed and 88 were injured, whereas FCGI identified 15 dead and 60 wounded, One of deaths was Vietnamese. We can guess that ACRH was developed as a unilateral violence by Vietnamese from a point of view to consider the degree of damage comprehensively. In particular, it is proved that 100 Chinese who owned shops and houses were looted and suffered massive property losses on August 20th in Haiphong Chinatown. Secondly, Vietnamese perceived Chinese as unwelcome as they were economically superior to Vietnamese and only took care of their own interests. This was another cause. FCGI is wary that the economic power of overseas Chinese will threaten French capital and Chinese government and they will influence Vietnamese independence activities. Prior to the outbreak of ACRH, Vietnamese political groups and business circles were carrying out a campaign called the “Chinese Product Exclusion Movement” against the strong economic activities of overseas Chinese. Thirdly, the Nanking Nationalist Government tried to resolve ACRH diplomatically through the French Consulate in Guangzhou. Apart from this trial, Cantong and Guangxi provincial government also requested Chinese protection toward Chinese central government and the French Consulate with Cantong and Guangxi branch of Chinese Kuomintang. However, these diplomatic attempts ended in failure as FCGI perceived to handle the incident properly and suppress it well. Fourthly, the Haiphong Branch of Chinese Kuomintang played a great role to carry out Chinese protection against Vietnamese riots, investigate the victims, and release the Chinese from detention. However, Cantonese and Fukienese congregations were not able to get actively involve resolving ACRH as the congregations was a subordinate of FCGI. Vietnamese political groups appealed the solidarity between Vietnamese and Chinese not to influence the cooperation from Chinese government and the Chinese Kuomintang with ACRH.

A Clonorchis Sinensis in the Gallbladder: A Rare Case in Kuwait

Clonorchis Sinensis is an important foodborne pathogen. It is actively transmitted in far-East countries and Asia, especially in China. It enters the biliary system via ingestion of infected cysts. It is exceedingly rare to encounter such a presentation in the Middle East, particular in Kuwait. The presence of liver fluke in the biliary system may lead to adverse complications. We are presenting a case report describing quite an unusual gallbladder finding in a 55-year-old Chinese lady.

Phlegmasia Cerulea Dolens: A Life- and Limb-threatening Disease

Phlegmasia cerulea dolens (PCD) is a rare syndrome caused by venous thrombosis and characterised by a triad of limb oedema, cyanosis and pain. It requires early recognition as delay of treatment can cause gangrene, limb amputation and in extreme cases, death. A 67- year-old Chinese lady, with underlying hypertension, diabetes mellitus and dyslipidaemia presented to the emergency department with a 2 days history of pain, oedema and bluish discoloration over the entire left leg. She had a history of fall 6 months prior and since then she used a walking stick for mobilization. This patient underwent ultrasound doppler left lower limb , which showed features suggestive of long-segment left lower limb deep vein thrombosis. A diagnosis of PCD was made. Subsequently, she went for a CT angiogram and venography of the left lower limb which confirmed thrombosis of the left calf vein extending to the long segment of the left common iliac vein. She was commenced on intravenous heparin infusion and then underwent inferior vena cava filter insertion and catheter directed thrombolysis. Repeat venogram showed successful catheter directed thrombolysis of the left lower limb deep venous thrombosis (DVT). Treatment should be initiated as soon as the diagnosis of PCD is suspected. Currently, guidelines for treatment are lacking however 3 therapeutic options are advocated alone or in combination: anticoagulants, thrombolytic therapy, and venous thrombectomy. An early recognition of PCD and appropriate decision regarding the treatment is essential to preserve the limb.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S16

The Chinese Lady: Afong Moy in Early America

The Chinese Lady: Afong Moy in Early America

P-PN010. Critical illness Polyneuropathy

Introduction. Critical Illness Polyneuropathy (CIP) is a frequent complication of critical illness, acutely and primarily affecting the motor and sensory axons. CIP delays weaning from mechanical ventilation, increases the length of stay at the intensive care unit, compromises rehabilitation and may result in a lifelong loss of function and in a reduction in quality of life. Greater than 50% of patients mechanically ventilated for more than 7 days will develop electrophysiological abnormalities with 25-33% developing clinically overt weakness. Until recently, no therapeutic measures had been proven to affect its incidence, and apart from supportive treatment. Results. A 52-year-old chinese lady presented to ED with shortness of breath due to SIRS et. causa pneumonia was consulted to neurology department because of loss of conciousness. After being intubated, patient awakened within stable condition. On neurological examination, there were bilateral ptosis, bilateral ophthalmoplegia, flaccid over all extremities, decrease of tendon reflexes and sensory were intact. There were leukocytosis and respiratory acidosis on laboratory findings. Chest X-ray noticed bilateral minimal pleural effusion and cardiomegaly. Bronchoscopy and Thorax CT-scan found inflammation. Abdominal ultrasound and head CT scan were within normal limits. Lumbar puncture was not done due to rejection from the family. On EDX findings, NCS found axonal loss pattern in motor and sensory, RNS was within normal limits and needle EMG findings noted distal pattern of decreased recruitment with denervation. After 18 months being hospitalised in ICU and using mechanical ventilator, the patient died. Conclusion. There is no direct treatment for CIP. CIP results in substantial morbidity, mortality, costs and could likely be improved with earlier diagnosis and more timely intervention. To achieve this goal, however, more awareness on the part of medical establishment is needed, as well as further research into the causes of treatments for CIP.

The Chinese Lady

Magic Theatre’s San Francisco production of Lloyd Suh’s The Chinese Lady plays with theatrical time to stage a confrontation between the 19th-century American past and the Trump-era present.

The Chinese Lady: Afong Moy in Early America by Nancy E. Davis

Reviewed by: The Chinese Lady: Afong Moy in Early America by Nancy E. Davis Yiyun Huang (bio) Keywords China, Chinese immigration, Afong Moy The Chinese Lady: Afong Moy in Early America. By Nancy E. Davis. (New York: Oxford University Press, 2019. Pp. 331. Cloth, $29.95.) Afong Moy was very likely the first Chinese woman who ever set foot on American soil when she arrived in New York City in 1834. Historians who study Chinese immigration to America have overlooked Moy and others like her. They typically focus on the mid-to-late nineteenth century when the California Gold Rush and the First Transcontinental Railroad spurred an influx of foreign people into the United States. As a result, little light has been focused on Afong Moy until now. Nancy E. Davis's [End Page 159] new book explores Moy's encounter with antebellum United States. She skillfully and painstakingly reconstructed some important episodes during Moy's sixteen-year sojourn (1834–1850) in America. The attention and comments Moy attracted during this period both diverge from and foreshadow what happened to the Chinese immigrants in the 1860s and 1870s. Her experience also reflected how the Americans thought about racial minority groups during the antebellum era. The Chinese Lady first provides important contextual information about America's China trade to better explain why and how several American merchants and a ship captain brought Afong Moy from Guangzhou (Canton) back to the United States. They arrived at New York City in 1834, and Moy's manager wasted no time in establishing a Chinese-style parlor to showcase and promote the newly imported objects. Afong Moy was attired in elite Chinese female clothing and sat in the midst of the goods. Moy served as a cultural bridge for Americans who used to know about China and the Chinese only through imported objects and newspaper reports. From 1834 to 1837, Afong Moy's role turned from the promoter of goods to that of a spectacle as she took a journey through the mid-Atlantic, New England, the South, Cuba, and up the Mississippi River. She presented Chinese culture in theaters and often shared stages with itinerant musicians and magicians. In the meantime, Afong Moy experienced some of the most well-known upheavals of this era, including Native American removal. The financial panic in 1837 changed Moy's life. Her sponsors went bankrupt and cast her aside. Moy had been in the United States for more than three years but did not have much opportunity to learn English. She could not find any means to support herself and ended up in a New Jersey almshouse. She took to the stage again between 1845 and 1850. We do not know when she died or if she returned to China. But after 1850, her name stopped appearing in any newspaper advertisements and her manager's account book (264). Davis's focus on Afong Moy provides insights on how Americans viewed China and the Chinese two decades prior to the influx of Chinese immigrants. In the 1830s, the American public responded to China in a generally positive way. They viewed it as a distant, exotic, and enchanting country with "fine silks and arched bridges" (238). The Chinese textiles and accessories Moy helped market to American consumers "indicated a worldly familiarity" and facilitated middle-class pursuits of objects that conferred status (80). However, the public's attitudes toward [End Page 160] China became more negative after China's defeat in the First Opium War and the subsequent opening of four ports in the early 1840s. The press now described Afong Moy as an uneducated and prideful woman who sharply contrasted with the "advanced position and sensibilities" of American women (256). Some authors even used Afong Moy as a model in stories that highlighted the unacceptable treatment of women in China. These unfriendly attitudes toward Moy in the 1840s foreshadowed the anti-Chinese sentiment two decades later, which culminated in the enactment of the Chinese Exclusion Act in 1882. The Chinese Lady also reveals how Americans in the 1830s and 1840s perceived racial minority groups as Afong Moy's experience echoed that of the Native Americans. Many people actually placed Moy...

5-Year Progressive Bull's Eye Maculopathy Despite Cessation of Hydroxychloroquine in Asian Systemic Lupus Erythematosus Lady

A 57-year-old systemic lupus erythematosus Chinese lady with maintenance hydroxychloroquine (HCQ) therapy of 200mg daily for 21years was weighed 61.5 kg-67.7 kg (mean 65.6 kg) throughout [1]. Regular ophthalmological tests in past decades first revealed subtle retinal pigment epithelium (RPE) changes, simulating early pericentral retinopathy pattern, on 2014’s fundus autofluorescence photos (Figure-1), and HCQ was immediately stopped [2,3]. Bull’s eye maculopathy was progressing inferiorly (Figure-2), to a combined parafoveal and pericentral retinopathy pattern (Figure-3), eventually generalized RPE atrophy (Figure-4) [3,4]. Safety HCQ dosage is 5mg/kg/day, yet retinal toxicity risk increases with consumption duration [1]. Maculopathy could progress after cessation of HCQ, given its long half-life of >1month [5].

Behcet's Disease Diagnosed by Allergy Skin Testing and Positive Pathergy Test

A 37-year-old Chinese lady with no significant past medical history was referred to our Allergy Clinic for a suspected drug hypersensitivity reaction (DHR). Three months earlier, she experienced a maculopapular rash on the abdomen 1 day after a cesarean section under spinal anesthesia. Her reaction was complicated by wound dehiscence with superimposed infection. A delayed-type DHR was suspected.

Neuropsychiatric masquerades: Distinguishing neurodegenerative disease from bipolar disorder.

Multiple medical or neurological conditions may mimic or contribute to a patient's neuropsychiatric symptoms. In a retrospective chart review of 252 patients with a neurodegenerative disease who attended a specialty clinic, it was found that 28.2% of them received a prior psychiatric diagnosis (1). We herein present a clinical vignette involving an elderly Chinese lady with a historical diagnosis of bipolar disorder Type 1, admitted to us to our tertiary setting for a supposed relapse episode.

MON-237 Primary Pituitary Lymphoma - an Unusual Guest in the Sella!

BackgroundPrimary Pituitary Lymphoma (PPL) is a rare differential diagnosis for a sellar / suprasellar lesion. Less than 40 cases have been reported.Case presentationA 75-year old Chinese lady with known subclinical hypothyroidism presented with 3-day history of dull frontal headache, giddiness and diplopia. Incomplete left cranial nerve (CN) III palsy was noted with no other neurological deficit or hemodynamic instability. MRI brain and pituitary showed a T1- and T2 isointense, 2.0 x 1.1 x 1.3 cm enhancing mass arising from the left sellar region, extending to the left sphenoid and cavernous sinuses, displacing the pituitary stalk towards the right, with no optic chiasm compression. There was no imaging evidence of apoplexy.Evaluation of anterior pituitary hormones revealed hypocortisolism (peak cortisol post 1mcg Synacthen 344 nmol/L, ACTH 3.5 ng/L [10 - 60]), subclinical hypothyroidism (free T4 9.6 pmol/L [8.8 - 14.4], TSH 7.19 mU/L [0.65 - 3.70]), normal prolactin 7.4 ug/L [5.0-27.7], mildly elevated IGF-1 193.7 mcg/L [67.0 - 189.0] with normal GH 1.0 ng/ml, and elevated FSH appropriate for menopause. Glucocorticoid replacement was started.Though the clinical presentation was not typical of a pituitary macroadenoma, in view of symptomatic improvement and neurological stability, she was conservatively managed with plans for early repeat imaging outpatient.Patient was readmitted 1 month later for headache and decreased left-sided visual acuity. A complete CN III palsy, and new CN II, IV and VI deficits were noted (orbital apex syndrome). Repeat MRI showed increase in the size of the sellar lesion to 2.6 x 2.1 x 1.3 cm, surrounding the optic nerve and with left cavernous and sphenoid sinus invasion. Again, there was no suggestion of apoplexy. Biopsy of the lesion was performed, and histology was consistent with Diffuse Large B-cell Lymphoma and Grade 3A Follicular Lymphoma with high proliferative index (Ki67 70%). Immunohistochemistry excluded carcinoma, meningioma and pituitary tumor. PET-CT and bone marrow aspirate confirmed the diagnosis of PPL without metastasis.After 3 cycles of chemotherapy (Methotrexate, Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone), significant decrease in the size of the lesion was noted on repeat MRI. Only mild asymmetric soft tissue thickening remained noticeable over the left sella and cavernous sinus. Cranial nerve deficits had since completely resolved. Glucocorticoid replacement was continued in the meantime while awaiting the completion of chemotherapy.ConclusionPPL may present in a similar manner as pituitary apoplexy. Absence of typical imaging characteristics of apoplexy in patients with rapid symptom progression and CN involvement should alert clinicians to consider alternative diagnosis including aggressive neoplastic, inflammatory and infective lesions.

A Rare Case of Propofol-Induced Acute Hepatitis in after a Brief Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

Background: Given its favourable pharmacokinetic parameters, propofol is commonly used for sedative procedures. The agent is extensively metabolized in the liver and there are sporadic reports of propofol induced acute hepatitis. Case: A 73-year-old Chinese lady underwent a routine endoscopic retrograde cholangio-pancreatography with propofol sedation who developed deranged liver function tests 4 hours post procedure peaking on day 1. She improved with conservative management only and no other causes for the clinical picture was found. A review of the literature revealed several case reports where propofol have been implicated as a triggering factor. Conclusion: Although propofol produces rapid recovery without major adverse effects in the vast majority of cases, it is worth bearing in mind the possibility of idiosyncratic reactions that are detrimental to the liver.

Review: The Chinese Lady: Afong Moy in Early America, by Nancy E. Davis

Review: <i>The Chinese Lady: Afong Moy in Early America</i>, by Nancy E. Davis