Successful endoscopic fragmentation of large hardened fecaloma using jumbo forceps

We present a rare case of fecaloma, 7 cm in size, in the setting of systemic scleroderma. A colonoscopy revealed a giant brown fecaloma occupying the lumen of the colon and a colonic ulcer that was caused by the fecaloma. The surface of the fecaloma was hard, large and slippery, and fragmentation was not possible despite the use of various devices, including standard biopsy forceps, an injection needle, and a snare. However, jumbo forceps were able to shave the surface of the fecaloma and break it successfully by repeated biting for 6 h over 2 d. The ability of the jumbo forceps to collect large mucosal samples was also appropriate for achieving fragmentation of the giant fecaloma.

Correlation of Thl7 cells and CD4＋CD25＋ regulatory T cells with clinical parameters in patients with systemic sclerosis

Background Systemic sclerosis （SSc） is an autoimmune disease that has three major components： inflammation, fibrosis, and vasculopathy. T-helper 17 cell （Th17） and regulatory T cell （Treg） are considered to be critical for autoimmune disease pathogenesis. The role of Th17 and Treg in SSc is still unclear. The aim of this study was to detect the presence of Th17s and CD4＊CD25~ Tregs in peripheral blood samples from SSc patients and to investigate the possible roles of these two T cell subsets in SSc pathogenesis. Methods Th17s （CD4 and IL-17 positive） and CD4＊CD25~ Tregs （CD4, CD25 and Foxp3 positive） in the peripheral blood mononuclear cells of 53 SSc patients and 27 healthy controls were counted by flow cytometry. The differences between SSc and control patients were analyzed. Clinical parameters, including disease duration, duration of the second symptoms, Modified Rodnan Skin Score （MRSS）, anti-topoisomerase I antibody, anti-U1 ribonucleoprotein （RNP） antibody, systemic involvements, pulmonary function test （PFT） and high resolution computed tomography （HRCT） score were prospectively collected following EUSTAR （EULAR scleroderma trial and research group） protocols. The correlations between the experimental and clinical data were investigated. Results The ratio of Th17 in SSc patients was significantly elevated compared to healthy controls （8.74% vs. 4.41%, P 〈0.001）. The amount of Th17 was positively correlated with disease duration （R=-0.531, P=-0.013） and duration of the second symptoms （R=-0.505, P=0.023）. The ratio of CD4＊CD25＊ Treg in SSc patients also significantly differed from the healthy controls （3.04% vs. 2.24%, P=0.018）. Elevated Tregs were more frequently observed in patients with a high interstitial lung disease （ILD） score on computed tomography （24/36） compared with patients with normal ILD scores （4/12, ,P=-0.043）. Elevated Tregs were also more often observed in patients with low carbon monoxide diffusing capacity （DLCO） （24/34） compared with patients with normal DLCO （4/11, P=0.042）. Conclusions T cell abnormalities are remarkable in systemic sclerosis. Th17s proliferate and their numbers increase with lengthened disease duration. Th17s might participate in both inflammation and fibrosis by secreting IL-17. CD4＋CD25＋ Tress also proliferate in SSc and may play important roles in promoting fibrosis.

The five major autoimmune diseases increase the risk of cancer:epidemiological data froma large-scale cohort study in China

Background:Cancer incidence and mortality have received critical attention during the long-term management of morbidities in patients with autoimmune diseases(AIDs).This study aimed to investigate and compare the risk of cancer associated with five major AIDs in a large-scale Chinese cohort.Methods:A total of 8,120 AID patients consecutively admitted to a national tertiary referral center in China were included and followed-up for 38,726.55 patient-years,including those with systemic lupus erythematosus(SLE),rheumatoid arthritis(RA),Sjoren’s syndrome(SS),systemic scleroderma(SSc),and idiopathic inflammatory myositis(IIM).Demographic data,cancer incidence,predilecting sites and cancer onset time were recorded and compared among the five AIDs.Results:Four hundred and thirty(5.3%)patients developed cancer.Their median agewas 57.5 years and AID durationwas 79.8 months.The estimated total standardized incidence ratio(SIR)of cancer in AIDs patients was 3.37,with the highest SIR observed in IIM(4.31),followed by RA(3.99),SSc(3.77),SS(2.88)and SLE(2.58).The increased SIR of cancers in AID patients showed a female predominance(female vs.male:3.59 vs.2.77)and younger patient involvement(age<50 vs.≥50 years:4.88 vs.3.04).Patientswith SLE had increased SIRs for developing hematologic malignancies and solid tumors located in the urinary bladder,corpus uteri and cervix uteri.Patients with SS had a significantly high SIR for developing non-Hodgkin’s lymphoma.Within 3 years of IIM diagnosis,74.6%of the patients developed cancer and they had a high risk of ovarian cancer.RA was associated with a wide distribution of scancers,including non-Hodgkin’s lymphoma,gynecologic,urinary tract,thyroid gland and lung cancers.SSc patients had increased SIRs for developing cervical uterine,lung,and breast cancers.Conclusion:Patients with five major AIDs in China had an increased risk of developing cancer,with a predominance in women and younger patients,although cancer incidence,predilection sites and cancer onset time may vary greatly in each AID entity.