ObjectiveTo summarize the clinical features of ulcerative eolitis (UC) complicated by toxic megacolon for early diagnosis and proper treatment. MethodsSix cases of toxic megacolon in the patients suffered from UC in Peking Union Medical College Hospital from 1983 to 2010 were analyzed,and related literature was searched and reviewed.ResultsThe incidence of the toxic megacolon in the patients with UC in our center was 0.7％ (6/824),which was lower than those reported in the literature.There were always risk factors triggering the disease.The prognosis of the patients was poor,even after medical care and surgery intervention.Evaluation of the patients and making right timing to perform the surgery would improve the prognosis of the patients in foreign literature. ConclusionIt's crucial to make early diagnosis of the toxic megacolon in the patients suffered from UC. The right choice and timing to perform urgent surgery or selective surgery may improve their prognosis.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements.Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of digestive system involvement in SLE.We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day.She had rashes at onset,and developed fever,stomachache,hypotension and headache.Physical examination at admission indicated blood pressure 76/47mmHg(1 mmHg =0.133 kPa),heart rate 107 beats/min,warm acra.Murphy's sign was positive.Ultrasound suggested the enlarged gallbladder with surrounding hypoecho band yet no biliary calculi were found.A diagnosis of SLE was made,characteristic with distributive shock at the onset and AAC,complicated with neuropsychiatric lupus and lupus nephritis.She had an acute and severe course of disease,which had been relieved after treatment of high dose glucocorticoid and immunosuppressants.This case arouses clinicians to pay more attention to AAC as a rare form of disease flare in SLE.Early diagnosis of AAC is crucial to a favorable prognosis and in avoid of abdominal surgery.

Objective To investigate the clinical features of polymyositis and dermatomyositis ( PM/DM) with lym-phoma .Methods The clinical data , treatment and prognosis of PM/DM with lymphoma from 2000 to 2015 in Pe-king Union Medical College Hospital were retrospectively collected and analyzed .Results Ten cases of PM/DM patients complicated with lymphoma were recruited .6 were female and 4 was male.The mean ages of the diagnosis of PM/DM and lymphoma were 44.5 and 44.9 years old respectively .The average disease course from PM/DM to lymphoma was 4.7months.Six cases were dermatomyositis and 4 cases were polymyositis.Three cases had pulmo-nary fibrosis and 2 cases had arthritis .No case had a positive result of anti-Jo-1 antibody .The most frequent symp-toms complicated with lymphoma included as following:enlargement of lymph nodes (9 cases), fever (8 cases), splenomegaly(5 cases).The top 3 lymphoma biopsy specimen included lymph node (4 cases), skin(2 cases)and local mass(2 cases).All the 10 patients were diagnosed as non-Hodgkin lymphoma.4 cases were derived from T cell, 2 cases from B cell, and 4 cases with unknown origin .The clinical staging showed III B (4 cases) and IV B (6 cases).Immunosuppressant agents were given to treat PM/DM.During the follow-up period, 5 patients died, 4 patients received chemotherapy and 1 patient was lost .Conclusions The coincidence of PM/DM and lymphoma is not rare .The course between PM/DM and lymphoma is short , and the mortality is significant , which should arise the attention of clinicians .

Objective To compare the phenotypes of abnormal CD4+CD25-Foxp3+ T cells with traditional regulatory T cells (CD4+CD25+Foxp3+) in patients with untreated new-onset lupus (UNoL) and investigate their clinical relevance. Methods The expressions of surface markers (CD25, CD127, CCR4, GITR, CTLA-4) and intracellular marker(Foxp3) on the peripheral blood mononuclear cells from twenty-two UNoL patients were analyzed by flow cytometry analysis, and their clinical relevance were assessed. Results There were no significant differences between CD4+CD25-Foxp3+ and CD4+CD25+Foxp3- T cells in the expressions of GITR, CTLA--4 and CCR4 (P>0.05), but they were significantly lower than those of CD4+CD25+ Foxp3+ T cells in UNoL patients (P<0.01). The percentages of CD127low- in CD4+Foxp3+CD25high,CD4+Foxp3+ CD25low and CD4+Foxp3+CD25+ T cells were (93.8±3.5 )%, (93.7±2.3)% and (92.0±2.1)% respectively (P> 0.05), whereas the expressions of Foxp3 on CD4+CD127low- T subpopulations showed significant differences in CD4+CDI27low-CD25high (91.4±2.6)%, CD4+CD127low-CD25low (71.9±3.3)% and CD4+CD127low-CD25- (9.0± 2.2)% T cells(P<0.01 ). The frequency of CD+CCR4+CD25high T cells correlated negatively with SLEDAI (r=-0.695,P<0.001).and it was significantly lower in lupus nephritis patients(1.10±0.17)%compared with SLE patients without nephritis [(1.61±0.23)%,P<0.01]and healthy controls [(1.75±0.10)%,P<0.01], furthermore,the frequency of CD4+CCR4+CD25low-T cells in lupus nephritis was significantly higher than that in healthy controls[(11.5±2.3)%vs (8.0±1.0)%,P<0.01].Conclusion The increased CD4+CD25-Foxp3+ T cells in the Untreated Newonset Lupus(UNoL)patients mimic activated T effector cells.CD4+CD25high-CD127low-T cells can be used to isolate live CD4+CD25highFoxp3+regulatory T cells.CCR4+regulatory T cells may be involved in the pathogenesis of lupus nephritis.

Objective To investigate the level and influencing factors of stigma among patients with lung cancer, in order to provide evidence for staff nurses to take pertinent interventions for assisting patients to deal with stigma. Methods Totally 234 hospitalized patients with lung cancer were cross-sectional survey with General Demographic Questionnaire, Disease Information Questionnaire, Chinese version of Cataldo Lung Cancer Stigma Scale (CLCSS-CV). Results The total score of stigma was (72.35±10.85) points. The total scale score and each subscale score was divided by the item number. The mean score of CLCSS-CV was (2.68±0.40) points, the rate of the patients with lung cancer with moderate above stigma was 51.20% (120/234). The patients rated higher scores on the subscales of smoking (2.90±0.58) points, while lower scores on the subscales of discrimination (2.47 ±0.55) points. Multiple stepwise regression analysis showed that the number of children and the clinical stages were influencing factors of lung cancer stigma, where regression coefficients were -0.065, 0.136 respectively, coefficients of determination was 0.178. Conclusions Patients with lung cancer have a moderate or higher level of stigma. The medical staff should communicate with patients, evaluate the psychological status, impose public health education, mobilize the social support for assisting them to deal with stigma.

AIM: To observe the efficacy of 23G minimally invasive system combined with phacoemulsification in the treatment of cataract complicated with vitreoretinopathy.

METHODS: Totally 96 cases(103 eyes)of patients with cataract and vitreoretinopathy were divided into observation group(48 cases 51 eyes)and control group(48 cases 52 eyes)by computer random number method. Observation group was given 23G minimally invasive system combined with phacoemulsification and vitrectomy, and control group was given conventional phacoemulsification and vitrectomy. The changes of best corrected visual acuity(LogMAR visual acuity), intraocular pressure and corneal astigmatism degree were observed before operation and at 1, 3 and 6mo after operation, and the complications were observed as well.

RESULTS:At 1, 3 and 6mo after operation, the LogMAR visual acuity in the two groups were lower than those before operation, and they were gradually decreased(P<0.05), and the LogMAR visual acuity in observation group at the same time point were lower than those in control group(P<0.05). The intraocular pressure in the two groups was lower than that before operation, and it was with a gradual decrease trend(P<0.05), and the intraocular pressure in observation group was lower than that in control group at the same time(P<0.05). Compared with before operation, the corneal astigmatism degree was increased significantly in the two groups at 1mo after operation(P<0.05), and was decreased gradually to preoperative level at 6mo after operation and the corneal astigmatism degree at 1mo and 3mo after operation in observation group was lower than that in control group(P<0.05). The incidence rate of postoperative complications in observation group was lower than that in control group(P<0.05).

CONCLUSION: The 23G minimally invasive system combined with phacoemulsification has better efficacy than conventional surgery in the treatment of cataract complicated with vitreoretinopathy, and it is beneficial to the restoration of visual acuity, intraocular pressure, and corneal astigmatism degree, and it can reduce postoperative complications.

Objective To investigate whether Ivor-Lewis esophagectomy combined with adjuvant radiotherapy prevents lymphatic metastatic recurrence in esophageal cancer patients.Methods 113 Stage Ⅱ A esophageal squamous cell carcinoma patients after Ivor-Lewis esophagectomy were accpected mRNA expression of Mucin1 gene detection.Positive patients were enrolled into adjuvant radiotherapy group(with postoperative adjuvant radiotherapy).Negative patients were enrolled into control group (without postoperative adjuvant radiotherapy or chemotherapy).The radiotherapy area consisted of the neck,supraclavicular region and the superior mediastinum(including praesophageal and pratracheal region).Survival difference was compared by x2 test,the Kaplan-Meier method was performed to calculate the survival rate and recurrence rate.Logistic regressive analysis was performed to determined independent risk factors.Results The radiotherapy area lymphatic metastatic recurrence rate in adjuvant radiotherapy group(16.7％,5/30) was lower than patients without postoperative adjuvant radiotherapy (45.8％,38/83) (P ＜ 0.05).Only compared to positive patients without postoperative adjuvant radiotherapy(60.0％,6/10),the rate (16.7％,5/30) was significantly lower(P ＜ 0.01).Cancer recurrence was recognized in 48.6％ (55/113) patients within 3 year after operation,including 38.1％ (43/113) patients with radiotherapy area recurrence.In logistic analysis the T status (P＜ 0.01) and adjuvant radiotherapy (P ＜ 0.05) were independent risk factors of lymph node metastasis in the first 3 years after operation.Conclusion In Mucin1 mRNA-positive esophageal squamous cell carcinoma patients,adjuvant radiotherapy could significantly reduce the lymph node metastasis rate in the radiotherapy area after Ivor-Lewis esophagectomy.Compared with traditional therapeutic methods,Ivor-Lewis esophagectomy combined with adjuvant radiotherapy can achieve similar curative effects in Mucin1 mRNA-positive patients.

Objective To explore the status and influencing factors of the integrated service needs of medicine, pension, rehabilitation and care of the community elderly in order to provide a theoretical basis for the construction of an old-age service model in line with the national conditions. Methods A total of 330 elderly people from three communities in Tai'an were selected and investigated by self-made questionnaire of the integrated services needs for medicine, pension, rehabilitation and care of community elderly. Results Nearly 83.54％(259/310) of the elderly had moderate and above pension needs, and the first three were rehabilitation services, family beds and community public health services. Age, educational level, self-rated health and number of chronic diseases were the influencing factors of the integrated service needs of medicine, pension, rehabilitation and care(t =2.374-4.844, all P<0.05). Conclusions The majority of elderly people have the moderate and above health care integration service demand, the elderly have the highest demand for rehabilitation services. Age, education, self-rated health status and the number of chronic diseases have different influence on the needs of the elderly;government, society, education and medical treatment institutions interdisciplinary multi linkage, and strengthen the professionals training of health, rehabilitation, health care, in order to explore the best old-age service model in line with national conditions.

AIM: To investigate dynamic changes of posterior corneal power and astigmatism after cataract surgery based on Pentacam three-dimensional anterior eye segment analyzer.

METHODS: Totally 96 elderly patients(116 eyes)with cataract underwent phacoemulsification combined with intraocular lens implantation in our hospital from January 2019 to January 2020 were selected. Parameters including anterior corneal power, posterior corneal power, flat keratometry, steep keratometry, mean keratometry, anterior corneal astigmatism, posterior corneal astigmatism, and total corneal astigmatism were obtained using Pentacam three-dimensional anterior eye segment analyzer system at postoperative 1wk, 1mo and 3mo. Spearan correlation analysis was performed on the anterior segment.

RESULTS: The anterior corneal power(flat keratometry, steep keratometry, mean keratometry)was lower at postoperative 1wk than that before operation, and began to return to the preoperative level at postoperative 1mo and 3mo. The posterior corneal power and total corneal power(flat keratometry, steep keratometry, mean keratometry)were higher at postoperative 1wk than before operation, and began to stabilize at postoperative 3mo. The anterior corneal astigmatism, posterior corneal astigmatism, and total corneal astigmatism were also higher at postoperative 1wk than before operation, and began to decrease and stabilize at postoperative 3mo. The anterior corneal power was significantly positively correlated with total corneal power; The posterior corneal power was significantly negatively correlated with the total corneal power, and was significantly positively correlated with its absolute value(P<0.05). The total corneal astigmatism before operation and at postoperative 1wk and 3mo was significantly positively correlated with anterior corneal astigmatism at corresponding time points(P<0.01), while showed no significant correlation with posterior corneal astigmatism.

CONCLUSION: Changes of posterior corneal power and astigmatism can be observed with 3mo of cataract surgery, and Pentacam three-dimensional anterior eye segment analyzer system can accurately assess the dynamic changes of anterior and posterior corneal power and astigmatism before and after operation, which is of great clinical value.

AIM: To observe the clinical effect of posterior chamber phakic refractive lens(PC-PRL)implantation in the treatment of ultra-high myopia.METHODS: Retrospective case study. A total of 36 patients(67 eyes)with ultra-high myopia who underwent PC-PRL implantation in our hospital from January 2021 to January 2022 were selected. They were and divided into two groups according to the preoperative spherical equivalent, with 16 cases(30 eyes)in spherical equivalent ≤-18.00D group and 20 cases(37 eyes)in spherical equivalent >-18.00D group. The preoperative and postoperative visual acuity, intraocular pressure(IOP), corneal endothelial cell density(ECD), central anterior chamber depth(ACD)and postoperative vault and complications were compared and analyzed.RESULTS: The uncorrected visual acuity(UCVA)at 3mo after operation of the two groups reached or exceeded the preoperative best corrected visual acuity(BCVA; all P<0.05), and the spherical equivalent >-18.00D group had a greater visual acuity improvement(P<0.01). There were significant differences in IOP and corneal ECD between the two groups at 1d after operation and before operation(all P<0.05); The vault at different time points decreased after operation, but it was within the normal range; The ACD at 3mo after operation was lower than that before operation(all P<0.01). There was no difference in intraocular pressure, ECD, ACD and postoperative vault between the two groups(P>0.05). No serious postoperative complications occurred in both groups.CONCLUSION: The PC-PRL implantation had improved early visual acuity and stable refractive state, which was safe and reliable, and there were no serious complications in the treatment of patients with ultra-high myopia.