Objective To investigate features of skin lesions of patients with systemic sclerosis (SSc),and to analyze the relationship of skin manifestations with clinical classification,autoantibodies and internal organ involvement.Methods Clinical data were collected from 120 patients with SSc in Department of Dermatology of Zhongshan Hospital Affiliated to Fudan University and Department of Scleroderma of Shanghai TCM-integrated Hospital between 2012 and 2014,and analyzed retrospectively.Results Among the 120 patients with SSc,118 (98.3％) had Raynaud's phenomenon,116 (96.7％) had skin sclerosis,including 101 (84.2％) with sclerosis of skin over the dorsum of fingers,90 (75％) had swollen skin,including 84 (70％)with swollen fingers,77 (64.2％) had poikiloderma,75 (62.5％) had thinned lip,74 (61.7％) had telangiectasia,63 (52.5％) had radial furrowing around the mouth,57 (47.5％) had mask-like face,49 (40.8％) had hyperplasia of nail cuticle,35 (29.2％) had petechiae of the nailfolds,25 (20.8％) had depressed fingertip,24 (20.0％) had atrophy of the finger pulp,24 (20.0％) had distal finger shortening,and 15 (12.5％) had fingertip ulcer.Anti-Scl-70 antibody and anti-centromere antibody (ACA) were positive in 42 (35.0％) and 31 (25.8％) patients respectively.The incidence of swollen fingers,fingertip ulcer,atrophy of the finger pulp was significantly higher in the anti-Scl-70 antibodypositive group than in the-negative group(P ＜ 0.05),and the incidence of sclerosis of skin over the dorsum of fingers,poikiloderma,fingertip ulcer and atrophy of the finger pulp was all significantly higher in the antiScl-70 antibody-positive group than in the ACA-positive group (P ＜ 0.05).The main internal organ involvement included interstitial lung disease (50％,44/88),cardiac involvement (47.8％,55/115),pulmonary arterial hypertension (35.7％,41/115),esophageal involvement (28.3％,34/120) and kidney involvement (9.2％,11/120).Patients with diffuse cutaneous systemic sclerosis (dcSSc) showed significantly higher incidence of cardiac involvement and poikiloderma compared with those with limited cutaneous systemic sclerosis (lcSSc) (P ＜ 0.01).Swollen fingers,sclerosis of skin over the dorsum of fingers,poikiloderma,telangiectasia,lip thinning,and radial furrowing around the mouth most commonly occurred in patients with early SSc,and swollen fingers and sclerosis of skin over the dorsum of fingers were highly correlated with the occurrence of pulmonary arterial hypertension.Telangiectasia,depressed fingertip and fingertip ulcer were significantly correlated with the occurrence of interstitial lung disease,and atrophy of the finger pulp was significantly correlated with the occurrence of cardiac involvement (both P ＜ 0.05).Conclusions Raynaud's phenomenon,swollen fingers,sclerosis of skin over the dorsum of fingers,poikiloderma,telangiectasia,lip thinning and radial furrowing around the mouth can be helpful for the early diagnosis of SSc.Pulmonary arterial hypertension commonly occurs in the early stage of SSc.Depressed fingertip and fingertip ulcer indicate the occurrence of interstitial lung disease,and the atrophy of the finger pulp indicates cardiac involvement.

Objective To investigate clinical characteristics of systemic sclerosis (SSc),and to explore the correlation between visceral involvement and autoantibodies.Methods Clinical data,laboratory examination and auxiliary examination findings were collected from 63 patients with SSc in the Department of Dermatology of Zhongshan Hospital affiliated to Fudan University between 2012 and 2015,and the correlation of autoantibodies with visceral involvement and clinical phenotypes was analyzed.Results The 63 patients with SSc included 29 with diffuse SSc,29 with limited SSc and 5 with overlapsyndrome.Of the 63 patients,30 had pulmonary interstitial fibrosis,32 had lung function impairment which manifested as reduced diffusing capacity for carbon monoxide,and 12 had increased pulmonary arterial pressure.Among 29 patients with anti-DNA topoisomerase Ⅰ (SCL-70) antibody,19 (65.52％) had pulmonary interstitial fibrosis,while 11 (32.35％) of 34 patients without anti-SCL-70 antibody had pulmonary interstitial fibrosis.Pulmonary interstitial fibrosis also occurred in 13 (68.42％) of 19 patients with anti-Sjogren's syndrome antigen A (SSA) antibody,as well as in 17 (38.64％) of 44 patients without anti-SSA antibody.The incidence of pulmonary interstitial fibrosis was significantly higher in the patients with anti-SCL-70 or anti-SSA antibody than in the patients without anti-SCL-70 or anti-SSA antibody respectively (x2 =6.901,4.720,respectively,both P ＜ 0.05).Among the 63 patients,22 had fingertip ulcers,and 16 (72.73％) of the 22 patients had pulmonary interstitial fibrosis,while 14 (34.15％) of 41 patients without fingertip ulcers had pulmonary interstitial fibrosis,and the incidence of pulmonary interstitial fibrosis significantly differed between the two groups (x2 =8.544,P ＜ 0.01).Of the 63 patients,50 (79.40％) initially presented with Raynaud's phenomenon,and the average duration between the occurrence of Raynaud's phenomenon and the diagnosis of SSc was 48.3 months.Conclusions Patients with SSc usually present with a high incidence of pulmonary interstitial fibrosis,which is complicated by lung function impairment and pulmonary hypertension.Raynaud's phenomenon usually occurs as the initial symptom.There is a high incidence of pulmonary interstitial fibrosis in the patients with fingertip ulcers and anti-SCL-70 and anti-SSA antibodies.

Objective To investigate the changes of electrocardiogram in elderly patients with acute cerebral ischemic infarction (CIS),and to analyze the relationship between the electrocardiogram and the prognosis of the patients.Methods 132 elderly patients with acute CIS in the hospital from January 2013 to December 2016 were enrolled.12 lead electrocardiogram was performed within 48 hours after onset and 7 days after onset,and the relationship between electrocardiogram abnormality and infarct type,severity,and prognosis were analyzed.The independent predictors of poor prognosis based on improved Rankin's score at discharge were evaluated.Results 83 cases (62.88％) had abnormal electrocardiogram.The main type of abnormal electrocardiogram was S-T segment abnormalities,followed by arrhythmia.The severity of illness in patients with abnormal electrocardiogram were significantly more serious than in those who did not detect abnormal electrocardiogram (P ＜ 0.05).The severity of illness in patients detected abnormal electrocardiogram over 2 times were significantly more serious than in those who detected abnormal electrocardiogram only within 48 hours after onset or 7 days after onset (P ＜ 0.05).Shorter time from onset to admission,complete anterior circulation infarction according to Oxfordshire Community Stroke Project (OCSP)classification,abnormal electrocardiogram (＞ 2 times) were independent risk factors for poor prognosis at discharge (P ＜ 0.05).Conclusions Electrocardiogram abnormity is common in elderly patients with CIS,and abnormal electrocardiogram detected over 2 times may indicate poor prognosis,which will benefit for the treatment schemes of patients.