A 71-year-old man who was recently hospitalized for COVID-19 pneumonia complicated by acute hypoxemic respiratory failure and severe ARDS requiring noninvasive ventilation was transferred to our hospital from a rehabilitation facility for new onset right wrist and hand pain and swelling which had been attributed to arterial thrombosis and empirically treated with therapeutic anticoagulation. He developed numbness and paralysis in his right hand and was diagnosed with right forearm compartment syndrome requiring emergent fasciotomy. After a prolonged hospital stay complicated by respiratory failure requiring mechanical ventilation, he was discharged with improved, but not resolved, sensorimotor deficits. Arterial blood gas sampling is commonly performed in patients with acute hypoxemic respiratory failure, for assessment of oxygenation and acid-base status. It is considered a benign procedure, but it can lead to serious complications, such as bleeding and compartment syndrome. Risks and benefits of any procedure need to be weighed carefully and less is often more. Compartment syndrome is characterized by the 5 P's—pain, pallor, paresthesia, pulselessness, and paralysis.
{"title":"Development of Compartment Syndrome after Radial Artery Puncture in a Patient with Acute Hypoxemic Respiratory Failure due to COVID-19","authors":"O. Garner, K. Nunna, A. Braun","doi":"10.1155/2022/8241057","DOIUrl":"https://doi.org/10.1155/2022/8241057","url":null,"abstract":"A 71-year-old man who was recently hospitalized for COVID-19 pneumonia complicated by acute hypoxemic respiratory failure and severe ARDS requiring noninvasive ventilation was transferred to our hospital from a rehabilitation facility for new onset right wrist and hand pain and swelling which had been attributed to arterial thrombosis and empirically treated with therapeutic anticoagulation. He developed numbness and paralysis in his right hand and was diagnosed with right forearm compartment syndrome requiring emergent fasciotomy. After a prolonged hospital stay complicated by respiratory failure requiring mechanical ventilation, he was discharged with improved, but not resolved, sensorimotor deficits. Arterial blood gas sampling is commonly performed in patients with acute hypoxemic respiratory failure, for assessment of oxygenation and acid-base status. It is considered a benign procedure, but it can lead to serious complications, such as bleeding and compartment syndrome. Risks and benefits of any procedure need to be weighed carefully and less is often more. Compartment syndrome is characterized by the 5 P's—pain, pallor, paresthesia, pulselessness, and paralysis.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82956446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Ghosh, S. Bhushan, L. D. López, D. Sampat, Z. Salah, C. Hatoum
Immune thrombocytopenic purpura (ITP) has been reported following vaccinations such as MMR as well as after viral infections such as hepatitis C and HIV. Few case reports have been reported of ITP after COVID-19 infections and COVID-19 vaccines. Herein, we present a patient who presented with severe ITP with a platelet count of 0 after receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine (also known as the Pfizer BioNTech). She subsequently recovered with a prolonged treatment course.
{"title":"BNT162b2 COVID-19 Vaccine Induced Immune Thrombocytopenic Purpura","authors":"A. Ghosh, S. Bhushan, L. D. López, D. Sampat, Z. Salah, C. Hatoum","doi":"10.1155/2022/5603919","DOIUrl":"https://doi.org/10.1155/2022/5603919","url":null,"abstract":"Immune thrombocytopenic purpura (ITP) has been reported following vaccinations such as MMR as well as after viral infections such as hepatitis C and HIV. Few case reports have been reported of ITP after COVID-19 infections and COVID-19 vaccines. Herein, we present a patient who presented with severe ITP with a platelet count of 0 after receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine (also known as the Pfizer BioNTech). She subsequently recovered with a prolonged treatment course.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77715975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myiasis refers to the infestation of living vertebrae with fly larvae, principally occurring in individuals with a low socioeconomic status and poor personal hygiene. Myiasis is rarely manifested in the urogenital system. Herein, we report a case of urogenital myiasis in a 49-year-old rural woman complaining of maggots in the urine and severe genital itching.
{"title":"A Rare Case of Urogenital Myiasis in a 49-Year-Old Woman","authors":"A. Salehi, E. Jenabi, Maral Salehi","doi":"10.1155/2022/7910176","DOIUrl":"https://doi.org/10.1155/2022/7910176","url":null,"abstract":"Myiasis refers to the infestation of living vertebrae with fly larvae, principally occurring in individuals with a low socioeconomic status and poor personal hygiene. Myiasis is rarely manifested in the urogenital system. Herein, we report a case of urogenital myiasis in a 49-year-old rural woman complaining of maggots in the urine and severe genital itching.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76338573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Ogunkoya, T. Solaja, A. F. Ogunlade, M. Ogunmola
Introduction Endometriosis is defined as a chronic gynecologic disease which is characterized by the presence of endometrial glands and stroma in anatomical sites and organs outside the uterine cavity. The exact prevalence of endometriosis is difficult to determine because many women remain asymptomatic. However, endometriosis affects about 10% to 15% of women. Thoracic endometriosis (TES) is the most common endometriosis outside the abdominopelvic cavity. It refers to endometriosis within the thoracic cavity including the lung parenchyma, diaphragm, and pleural surfaces. It can manifest as catamenial chest pain, pneumothorax, hemoptysis, hemothorax, catamenial haemoptysis, and pulmonary nodules. Case Summary. A 39-years-old married female presented with recurrent right-sided chest pain of 22 years duration, recurrent cough of more than 20 years and progressive breathlessness of a month duration. The chest pain is pleuritic, and it often starts few days to the onset of her menses and lasts throughout menstrual flow only to abate after the stoppage of menstrual bleeding. Cough was unproductive, paroxysmal often worse with worsening chest pain. It disappears after the end of menstrual bleed. Breathlessness was initially on mild to moderate exertion before progressing to occasional breathlessness at rest. No history of orthopnea, paroxysmal nocturnal dyspnea, and pedal swelling was found. Over the years, she had presented to several clinics where she was said to have menstrual pain referred to the chest. Conclusion Diagnosis of extrapelvic endometriosis can be challenging and delayed because it presents in a myriad of ways and in some cases, it may be difficult to link symptoms and the menstrual cycle.
{"title":"Thoracic Endometriosis: A Presentation of an Uncommon Disease in a Black African Woman","authors":"J. Ogunkoya, T. Solaja, A. F. Ogunlade, M. Ogunmola","doi":"10.1155/2022/2380700","DOIUrl":"https://doi.org/10.1155/2022/2380700","url":null,"abstract":"Introduction Endometriosis is defined as a chronic gynecologic disease which is characterized by the presence of endometrial glands and stroma in anatomical sites and organs outside the uterine cavity. The exact prevalence of endometriosis is difficult to determine because many women remain asymptomatic. However, endometriosis affects about 10% to 15% of women. Thoracic endometriosis (TES) is the most common endometriosis outside the abdominopelvic cavity. It refers to endometriosis within the thoracic cavity including the lung parenchyma, diaphragm, and pleural surfaces. It can manifest as catamenial chest pain, pneumothorax, hemoptysis, hemothorax, catamenial haemoptysis, and pulmonary nodules. Case Summary. A 39-years-old married female presented with recurrent right-sided chest pain of 22 years duration, recurrent cough of more than 20 years and progressive breathlessness of a month duration. The chest pain is pleuritic, and it often starts few days to the onset of her menses and lasts throughout menstrual flow only to abate after the stoppage of menstrual bleeding. Cough was unproductive, paroxysmal often worse with worsening chest pain. It disappears after the end of menstrual bleed. Breathlessness was initially on mild to moderate exertion before progressing to occasional breathlessness at rest. No history of orthopnea, paroxysmal nocturnal dyspnea, and pedal swelling was found. Over the years, she had presented to several clinics where she was said to have menstrual pain referred to the chest. Conclusion Diagnosis of extrapelvic endometriosis can be challenging and delayed because it presents in a myriad of ways and in some cases, it may be difficult to link symptoms and the menstrual cycle.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"18 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74641557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Tabarsi, S. Sharifynia, M. Pourabdollah Toutkaboni, Z. Abtahian, M. Rahdar, A. Mirahmadian, A. Hakamifard
Acute invasive fungal rhinosinusitis (AIFR) is a life-threatening infection often found in immunocompromised patients. In the COVID-19 era, reports of AIFR have emerged, with high mortality and morbidity rate. This paper presents two cases of COVID-19 associated AIFR with the combined proven fungal etiology of Aspergillus flavus and Rhizopus arrhizus in case 1 and Aspergillus fumigatus and Rhizopus arrhizus in case 2. Both patients received liposomal amphotericin B then posaconazole combined with aggressive surgical debridement of necrotic tissues with a favorable clinical outcome. Mixed etiology AIFR can influence the outcome; hence, further studies are required upon this new threat.
{"title":"Coinfection by Aspergillus and Mucoraceae Species in Two Cases of Acute Rhinosinusitis as a Complication of COVID-19","authors":"P. Tabarsi, S. Sharifynia, M. Pourabdollah Toutkaboni, Z. Abtahian, M. Rahdar, A. Mirahmadian, A. Hakamifard","doi":"10.1155/2022/8114388","DOIUrl":"https://doi.org/10.1155/2022/8114388","url":null,"abstract":"Acute invasive fungal rhinosinusitis (AIFR) is a life-threatening infection often found in immunocompromised patients. In the COVID-19 era, reports of AIFR have emerged, with high mortality and morbidity rate. This paper presents two cases of COVID-19 associated AIFR with the combined proven fungal etiology of Aspergillus flavus and Rhizopus arrhizus in case 1 and Aspergillus fumigatus and Rhizopus arrhizus in case 2. Both patients received liposomal amphotericin B then posaconazole combined with aggressive surgical debridement of necrotic tissues with a favorable clinical outcome. Mixed etiology AIFR can influence the outcome; hence, further studies are required upon this new threat.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"52 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84695248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Alsmady, Rahaf A Al-Qaryouti, Nesrin G. Sultan, Oweiss Khrais, Huthaifah Khrais
This report describes a case of a 60-year-old male patient who received the first dose of the AstraZeneca vaccine and presented to the emergency department complaining of left hand pain and paresthesia. Investigations revealed upper limb ischemia; he was hospitalized for further management.
{"title":"Upper Limb Ischemia Due to Arterial Thrombosis after COVID-19 Vaccination","authors":"M. Alsmady, Rahaf A Al-Qaryouti, Nesrin G. Sultan, Oweiss Khrais, Huthaifah Khrais","doi":"10.1155/2022/4819131","DOIUrl":"https://doi.org/10.1155/2022/4819131","url":null,"abstract":"This report describes a case of a 60-year-old male patient who received the first dose of the AstraZeneca vaccine and presented to the emergency department complaining of left hand pain and paresthesia. Investigations revealed upper limb ischemia; he was hospitalized for further management.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87334760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Le Viet Dung, Ma Mai Hien, Dang-Thi Bich Nguyet, T. Tra My, N. M. Minh Duc
Although mycotic (infected) aneurysms are uncommon, they can affect any artery. The most frequently involved vessel is the aorta as well as femoral and cerebral arteries. A vascular-colonic fistula from infected aneurysms is even rarer, which remains a challenge for diagnosis and treatment. In this case report, we aimed to illustrate an 89-year-old man presenting initially with an aneurysm of the right common iliac artery. Forty days later, this lesion was infected and produced fresh blood in the rectum and sigmoid colon observed by colonoscopy. The final diagnosis of this case was a right common iliac artery aneurysm-colonic fistula due to infection. The patient was successfully diagnosed and treated with surgery at our hospital.
{"title":"Mycotic Aneurysm with Iliac Artery-Colonic Fistula","authors":"Le Viet Dung, Ma Mai Hien, Dang-Thi Bich Nguyet, T. Tra My, N. M. Minh Duc","doi":"10.1155/2022/3250749","DOIUrl":"https://doi.org/10.1155/2022/3250749","url":null,"abstract":"Although mycotic (infected) aneurysms are uncommon, they can affect any artery. The most frequently involved vessel is the aorta as well as femoral and cerebral arteries. A vascular-colonic fistula from infected aneurysms is even rarer, which remains a challenge for diagnosis and treatment. In this case report, we aimed to illustrate an 89-year-old man presenting initially with an aneurysm of the right common iliac artery. Forty days later, this lesion was infected and produced fresh blood in the rectum and sigmoid colon observed by colonoscopy. The final diagnosis of this case was a right common iliac artery aneurysm-colonic fistula due to infection. The patient was successfully diagnosed and treated with surgery at our hospital.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"113 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73459504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aman Mishra, Sandip Kuikel, Robin Rauniyar, S. Poudel, Sital Thapa, Nibesh Pathak, Suman Rimal, Kundan Raj Pandey, S. Jha
Eosinophilia can be caused by various conditions, parasitic infection being the most common cause. Here, we present a case of a 17-year male who presented with multisystem involvement and eosinophilia. He was later diagnosed to have systemic lupus erythematosus with eosinophilia which is a rare combination. Despite being a diagnostic challenge, these patients can be well managed with immunosuppressive therapy if recognized in time.
{"title":"An Unusual Case of Eosinophilia with Systemic Lupus Erythematosus: A Case Report and Review of Literature","authors":"Aman Mishra, Sandip Kuikel, Robin Rauniyar, S. Poudel, Sital Thapa, Nibesh Pathak, Suman Rimal, Kundan Raj Pandey, S. Jha","doi":"10.1155/2022/3264002","DOIUrl":"https://doi.org/10.1155/2022/3264002","url":null,"abstract":"Eosinophilia can be caused by various conditions, parasitic infection being the most common cause. Here, we present a case of a 17-year male who presented with multisystem involvement and eosinophilia. He was later diagnosed to have systemic lupus erythematosus with eosinophilia which is a rare combination. Despite being a diagnostic challenge, these patients can be well managed with immunosuppressive therapy if recognized in time.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"58 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91298041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charisma Mylavarapu, Alexander J. Lu, E. Burns, Justin Samorajski, D. Gotur, K. Baker
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease characterized by the formation of cutaneous and visceral telangiectasias and arteriovenous malformations (AVM). Multiple organs may be affected, including the nasal mucosa, skin, lungs, gastrointestinal tract, and brain. The following case highlights a unique manifestation of HHT in a patient with a gastrointestinal hemorrhage and epistaxis, resulting in hyperammonemia and diffuse cerebral edema and herniation. Clinicians should be aware of this potential complication in such patients and initiate ammonia-reducing agents early to avoid this devastating consequence.
{"title":"Diffuse Cerebral Edema and Impending Herniation Complicating Hepatic Encephalopathy in Hereditary Hemorrhagic Telangiectasia","authors":"Charisma Mylavarapu, Alexander J. Lu, E. Burns, Justin Samorajski, D. Gotur, K. Baker","doi":"10.1155/2022/2612544","DOIUrl":"https://doi.org/10.1155/2022/2612544","url":null,"abstract":"Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease characterized by the formation of cutaneous and visceral telangiectasias and arteriovenous malformations (AVM). Multiple organs may be affected, including the nasal mucosa, skin, lungs, gastrointestinal tract, and brain. The following case highlights a unique manifestation of HHT in a patient with a gastrointestinal hemorrhage and epistaxis, resulting in hyperammonemia and diffuse cerebral edema and herniation. Clinicians should be aware of this potential complication in such patients and initiate ammonia-reducing agents early to avoid this devastating consequence.","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"197 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79952337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basilar predominant emphysema, or disproportionate emphysematous involvement of the lung bases compared to the apices, is an uncommon radiographic pattern of emphysema traditionally associated with alpha-1-antitrypsin deficiency (AATD). We present a case of a 59-year-old female with 41 pack-year tobacco use, Stage IV COPD with supplemental oxygen, and bibasilar predominant emphysema who successfully underwent bronchoscopic lung volume reduction. She presented with recurrent hospitalizations for frequent exacerbations. After lung reduction, the patient displayed improvement in functional status without hospitalizations at the 15-month follow-up. Careful history taking is essential for any patients diagnosed with lower lobe emphysema to elucidate the underlying etiology. This case challenges the notion that basilar emphysema is sensitive or specific for AATD and emphasizes that this pattern of emphysema has a broad differential diagnosis and alternative etiologies should be considered. Our patient was ultimately diagnosed with smoking-related emphysema, with atypical bibasilar involvement. Furthermore, basilar predominant emphysema should be considered a separate entity from its apical predominant counterpart.
{"title":"Basilar Predominant Emphysema: Thinking beyond Alpha-1-Antitrypsin Deficiency.","authors":"Ho-Man Yeung, Lauren Gaffaney","doi":"10.1155/2022/9840085","DOIUrl":"https://doi.org/10.1155/2022/9840085","url":null,"abstract":"<p><p>Basilar predominant emphysema, or disproportionate emphysematous involvement of the lung bases compared to the apices, is an uncommon radiographic pattern of emphysema traditionally associated with alpha-1-antitrypsin deficiency (AATD). We present a case of a 59-year-old female with 41 pack-year tobacco use, Stage IV COPD with supplemental oxygen, and bibasilar predominant emphysema who successfully underwent bronchoscopic lung volume reduction. She presented with recurrent hospitalizations for frequent exacerbations. After lung reduction, the patient displayed improvement in functional status without hospitalizations at the 15-month follow-up. Careful history taking is essential for any patients diagnosed with lower lobe emphysema to elucidate the underlying etiology. This case challenges the notion that basilar emphysema is sensitive or specific for AATD and emphasizes that this pattern of emphysema has a broad differential diagnosis and alternative etiologies should be considered. Our patient was ultimately diagnosed with smoking-related emphysema, with atypical bibasilar involvement. Furthermore, basilar predominant emphysema should be considered a separate entity from its apical predominant counterpart.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":"2022 ","pages":"9840085"},"PeriodicalIF":0.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9757930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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