A 56-year-old female was admitted to Department of Gastroenterology at Peking Union Medical College Hospital with diarrhea for seven months, and abnormal liver function for six months. She had a history of type 1 diabetes. The main clinical manifestations were recurrent fatty diarrhea and abnormal liver function, accompanied by abdominal and retroperitoneal lymphadenopathy, elevated CA19-9 and CEA. Progressive impairment of hepatic synthetic function and shrinkage of liver developed in a short period of time. The pathology of liver biopsy suggested that nodular regeneration of hepatocytes was followed by hyperplasia of thin bile ducts after submassive necrosis. Intestinal mucosa biopsies were performed twice. The pathology showed that the intestinal villi were completely blunt, accompanied with crypt hyperplasia. Goblet cells disappeared with reduced mucin. Paneth cells were barely seen without intraepithelial infiltration of lymphocytes. Rifaximin was not effective, while glucocorticoids improved clinical situation. The diagnosis of autoimmune enteropathy was finally confirmed by multidisciplinary team including departments of gastroenterology, pathology, endocrinology, hematology, infectious diseases, and rheumatology. With the administration of glucocorticoid and sirolimus, diarrhea relieved and liver function returned to normal.

Objective:To explore the effect of nursing based on knowledge, attitude and practice theory in the prevention of postoperative stoma infection in patients with bladder cancer.Methods:Using the convenient sampling method, a total of 78 patients with bladder cancer postoperative stoma who were hospitalized in Xuzhou Central Hospital from March 2016 to October 2020 were selected as the research objects. According to the random number table method, the patients were divided into the control group and the observation group, with 39 cases in each. The control group was given routine postoperative stoma nursing, while the observation group was given nursing based on knowledge, attitude and practice theory on the basis of the control group. After the intervention, the blood indexes (red blood cells, white blood cells, platelets and hemoglobin counts) related to stoma infection were compared between the two groups. Complications (hematuria, shock, urinary retention, wound rupture) were observed and recorded in the two groups; stoma infection during hospitalization and reinfection within 1, 3 and 6 months after surgery of the two groups were recorded.Results:After intervention, the red blood cell, hemoglobin and platelet counts in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The total incidence of postoperative complications of hematuria, shock, urinary retention and wound rupture in the observation group was 2.6% (1/39) , which was lower than 17.9% (7/39) in the control group, and the difference was statistically significant ( P<0.05) . There was 1 case (2.6%) of stoma infection in the observation group and6 cases (15.4%) in the control group, and the difference was statistically significant ( P<0.05) . Further follow-up showed that the proportions of reinfection in the observation group at 1, 3 and 6 months after surgery were lower than those in the control group, but there was no statistically significant difference between the two groups ( P>0.05) . Conclusions:Nursing based on the knowledge, attitude and practice theory can effectively improve the blood indexes related to infection after ostomy in bladder cancer patients and reduce the occurrences of complications and stoma reinfection.

Brain renin-angiotensin system (RAS) is closely associated with many pathophysiological processes of cardiocerebrovascular diseases,including stroke.The activation of the different components in RAS will produce specific biological effects.This article reviews the roles of brain RAS in the pathophysiological processes of ischemic stroke,especially the neuroprotective effect of ACE2/Ang-(1-7)/Mas axis.

Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.