In This article we report 80 cases of psoriasis confined to the leg hand or foot of the patients. The diagnoses all been confirmed by definite pathological examinations of the cutaneous tissue. As this disease appears on peculiar sections of the body is affected by many physio-chemical factors, the form of cutaneous damage produces different changes of various degrees, so the typical damage is not shown usually. Therefore misdiagnosis leads us to consider it to be case of neurodermatitis, eczema, chronic dermatitis and tinea. The author has made analysis on causes of misdiagnosis and suggested methods to discern proper diagnosis of this disease.

Objective: Traditional Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy can greatly decrease the anastomosis-related complications and reduce the incidence of reflux esophagitis, but its complexity limits the wide application. To decrease the complexity of Kamikawa anastomosis, the surgical team of Changzhi People's Hospital of Shanxi Changzhi Medical College improved this technique by using novel notion and reduced surgical procedures. This study aims to evaluate the efficacy and safety of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy. Methods: A descriptive cohort study was carried out. Case enrollment criteria: (1) upper gastric carcinoma or esophagogastric junction carcinoma without distant metastasis was confirmed by preoperative gastroscopic biopsy and imaging examination; (2) tumor diameter was less than 4 cm; (3) preoperative clinical staging was cT1-3N1M0. Exclusion criteria: (1) patients received preoperative neoadjuvant chemotherapy; (2) patients had severe heart or lung disease, or poor nutritional status so that they could not tolerate surgery. Clinical data of 25 patients with upper gastric carcinoma or esophagogastric junction carcinoma who underwent modified Kamikawa anastomosis in digestive tract reconstruction in Heji Hospital (8 cases) and Changzhi People's Hospital (17 cases) from April 2019 to December 2020 were retrospectively collected. Of 25 patients, 21 were male and 4 were female, with mean age of 63.0 (49 to 78) years; 3 underwent open surgery and 22 underwent laparoscopic surgery. The modified Kamikawa anastomosis was as follows: (1) the novel notion of total mesangial resection of the esophagogastric junction was applied to facilitate the thorough removal of lymph nodes and facilitate hand-sewn anastomosis and embedding; (2) the diameter of the anastomotic stoma was selected according to the diameter of the esophageal stump, between 2.5 and 3.5 cm, to reduce the occurrence of anastomotic stenosis; (3) an ultrasonic scalpel was used to incise the esophageal stump, which could not only prevent bleeding of the esophageal stump, but also closely seal the esophageal mucosa, muscle layer and serosa to prevent esophageal mucosa retraction; (4) barbed suture was used to suture the remnant stomach fundus and esophagus to fix the stomach fundus in order to reduce the cumbersome and difficult intermittent sutures in a small space; (5) two barbed sutures were used to continuously suture the front and back walls of the anastomosis and complete the suture and fixation of the muscle flap. Relevant indicators of surgical safety, postoperative complications (using the Clavien-Dindo classification), esophageal reflux symptoms and the occurrence of esophagitis (using Los Angeles classification) were analyzed. The gastroesophageal reflux disease (GERD) score, gastroscopy, multi-position digestive tract radiography during postoperative follow-up were used to evaluate the residual gastric motility and anti-reflux efficacy. Results: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy was successfully performed in 25 patients. The surgical time was (5.8±1.8) hours, the intraoperative blood loss was (89.2±11.8) ml, and the average hospital stay was (13.8±2.9) days. Three cases (12.0%) developed postoperative anastomotic stenosis as Clavien-Dindo grade III and were healed after endoscopic dilation treatment. Postoperative upper gastrointestinal radiography showed 1 case (4.0%) with reflux symptoms as Clavien-Dindo grade I. Gastroscopy showed no signs of reflux esophagitis, and its Los Angeles classification was A grade. No anastomotic bleeding, local infection and death were found in all the patients. At postoperative 6-month of follow-up, GERD score showed no significant difference compared to pre-operation (2.7±0.6 vs. 2.4±1.0, t=-1.495, P=0.148). Conclusion: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy is safe and feasible with good anti-reflux efficacy.
Aged ; Anastomosis, Surgical ; Cohort Studies ; Esophagogastric Junction/surgery* ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Retrospective Studies

Objective To study the clinical significance of systemic lupus erythematosus disease activity index(SLEDAI) in the treatement of SLE. Methods Disease activity of every patient with SLE 10 days before admission and before discharging was assessed using the SLEDAI system. The patients were treated separately with prednisone, pulse methylprednisolone and/or pulse cyclophosphamide according to their conditions. Statistical analysis was carried out using SPSS software. Results ①The difference of SLEDAI between the patients before admission and discharging was significant (P

Objective To assess the histopathological characteristics of tumors arising in nevus sebaceous.Methods The clinical and pathological data on 16 patients with tumors arising in nevus sebaceous were collected and retrospectively reviewed.Histopathological characteristics were analyzed.Results Of the 16 patients,12 aged ≥ 18 years,4 aged 11 to 17 years; 7 had syringocystadenoma papilliferum(SCAP),4 tubular apocrine adenoma (TAA),3 trichilemmoma,2 basal cell carcinoma (BCC),1 porokeratotic eccrine ostial and dermal duct nevus,and 1 nevus flammeus.Six patients suffered from more than one kind of tumor,of these tumors,concurrent syringocystadenoma papilliferum and apocrine adenoma predominated and were observed in 4 of these patients.Conclusion Any tumor arising from nevus sebaceous should be closely followed up.

Objective To investigate the clinical and histological characteristics of trichilemmal carcinoma (TLC). Methods A clinicopathological analysis of 13 cases of TLC was carried out. Results There were 9 males and 4 females among the 13 patients with TLC who were aged from 34 to 87 years (mean: 70 years). Clinically, the tumor presented as an exophytic mass; histologically, it was characterized by the proliferation of epithelial cells and keratinization of outer root sheath. Cytologically atypical clear cells predominated in the tumor tissue. Microscopy revealed different growth patterns of tumor cells, which included solid growth pattern, tobular pattern and trabecular pattern. Periodic acid Schiff (PAS) stain demonstrated clear cells in all the tumor tissues from the 13 patients. Immunohistochemistry was performed in tissue samples from 6 patients, and showed that these samples were positive to high molecular weight cytokeratin (CK-HMW) and epithelial membrane antigen (EMA), but negative to carcinomebrynic antigen (CEA), S-100, cytokeratin 8 (CK8)and epithelial antigen(Ber-Ep4). Follow-up over 4 months to 5 years revealed neither recurrence nor metastasis in 9 cases.Conclusions TLC is a low-grade malignancy of skin adnexal tumor without distinctive clinical features, and should be differentiated from other malignant clear cell tumors of the skin.

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.
Anastomosis, Surgical/methods* ; Esophagogastric Junction/surgery* ; Gastrectomy/methods* ; Gastroesophageal Reflux/surgery* ; Humans ; Quality of Life ; Stomach Neoplasms/surgery*

Objective To study the organ damage in patients with systemic lupus erythematosus (SLE) and its significance in prognosis. Methods The SLE damage index (SDI) was used to evaluate 121 female and 15 male patients. Results Among these patients, the lowest and the highest SDI was 0 or 9, separately (average: 1.79 ? 2.22). Most damaged organ was renal (39.0%), followed by muscle/skeletal system (19.9%) and cardiovascular system (18.4%). There was statistically significant difference of SDI in different groups of prognosis, life condition or disease duration ( 10 years). However, there was no significant difference of SDI in different sex groups. The correlation analysis revealed that the age at onset or diagnosis was not related to SDI. Conclusion SDI is effective in evaluating the organ damage in predicting prognosis of SLE patients.

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.
Humans ; Stomach Neoplasms/surgery* ; Gastrectomy ; Gastroesophageal Reflux ; Esophagogastric Junction/surgery* ; Pylorus/pathology*

OBJECTIVETo investigate the relationship between major histocompatibility complex class I chain-related A(MICA) gene and systemic lupus erythematosus (SLE).

METHODSThe alleles and frequencies of exons 4 and 5 of MICA gene were determined in 70 cases of SLE and 152 controls of Yunnan Hans by STR genotyping, polymerase chain reaction, single strand conformation polymorphism and bidirection DNA sequencing.

RESULTSFive alleles of exon 5 and 10 alleles of exon 4 were found in this study. The frequency of each allele was determined in patients and controls. There was no significant difference between the two groups in exons 4 and 5 of MICA gene.

CONCLUSIONExons 4 and 5 of MICA were not related to SLE in Yunnan Hans.

Alleles ; China ; DNA ; genetics ; Female ; Gene Frequency ; Genotype ; Histocompatibility Antigens Class I ; genetics ; Humans ; Lupus Erythematosus, Systemic ; genetics ; Male ; Polymorphism, Single-Stranded Conformational

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome