2017年 · 第97卷第41期

glucocorticoid (GCS) has the effect of regulating the biosynthesis and metabolism of sugar, fat and protein, and also has the effect of suppressing immune response, anti-inflammatory, anti-toxic and anti-shock. Since its inception, it has been the first-line drug for immune-mediated diseases, or as an adjuvant drug for inflammatory, infectious or malignant diseases. However, with the increase of clinical practice, the "dual-sided nature" of glucocorticoids is also increasingly significant.

"Food is the heaven for the people", diet is necessary for people's survival, reasonable diet can not only prevent diseases, but also can cooperate with drugs to treat diseases. The relationship between dietary nutrition and rheumatism is very close. There are many discussions on diet and rheumatism at the 2016 Annual Meeting of the American College of Rheumatology and the 2017 European Anti-Rheumatic Alliance Congress. The just-released 2016 International Association for the Evaluation of Spondyloarthritis/European Anti-Rheumatic Alliance recommendations for axial spondyloarthritis treatment emphasize the importance of non-pharmaceutical treatments such as diet^[1]。 Current research has found that besides the effects of diet on heart disease, stroke and tumor, the effects on the body's immune system are particularly prominent^[2]。 Although the homology of medicine and food has a rich theoretical basis in China, domestic rheumatology professionals have insufficient understanding of diet in the prevention and treatment of rheumatism. Therefore, this paper discusses the scientific basis and clinical significance of dietary chaos and some dietary components in the pathogenesis and treatment of rheumatism in China, and draws the attention of rheumatology practitioners to dietary factors.

TCD can dynamically evaluate the craniocerebral circulation of patients at the bedside. Therefore, its monitoring value has been more and more affirmed and valued. This part mainly expounds the operation specification of TCD in the field of brain monitoring^[1,2,3]。

The 25-year-old male was admitted to Peking Union Medical College Hospital on August 16, 2016 due to intermittent diarrhea and fever for more than 4 years, oral vulvar ulcer for more than 1 year, and aggravation for 2 months. The patient went to the local hospital in June 2012 due to diarrhea and fever. Colonoscopy showed scattered superficial ulcers in the distal ileum, ileocecal region and ascending colon mucosa, and the treatment with mesalazine was effective. Since March 2015, he has repeated low fever, occasionally blurred vision and conjunctival congestion, and repeated oral ulcers and vulvar ulcers. In June 2015, he was hospitalized in Peking Union Medical College Hospital. The blood erythrocyte sedimentation rate (ESR) was 38 mm/1 h, and the high-sensitivity C-reactive protein (hsCRP) was 96.09 mg/L. Positive fecal occult blood; Gastroscopy showed multiple small ulcers of worm erosion in gastric fundus and gastric body; Colonoscopy showed scattered superficial aphthoid ulcers throughout the colon. He was diagnosed with Behcet's disease and gastrointestinal tract involvement. During his hospitalization, he had one major upper gastrointestinal bleeding, which improved after endoscopic clamp hemostasis. The primary disease was treated with high-dose prednisone, mesalazine, azathioprine, tacrolimus, thalidomide and intermittent use of cyclophosphamide, and the symptoms improved. Hormones were tapered to prednisone 12.5 mg once/d, azathioprine 100 mg once/d, and tacrolimus 2 mg once/d. Since June 2016, the patient had recurrent low fever, accompanied by oral ulcer, lower abdominal pain, and positive fecal occult blood. Prednisone was increased to 50 mg once/d, and azathioprine 50 mg once/d, tacrolimus 1 mg once/d, and thalidomide 75 mg once/d were given. The oral ulcer improved, but the abdominal pain was not relieved. On August 5, 2016, the patient was given methylprednisolone 80 mg once a day intravenously and cyclophosphamide 0.4 g once a week intravenously. The patient developed fever with a maximum body temperature of 39.5℃, accompanied by cough and yellow phlegm. Admitted to hospital on August 16, 2016. Past history, personal history, marriage and childbirth history, and family history are no different. Physical examination at admission: heart rate 70 beats/min, blood pressure 110/72 mmHg (1 mmHg =0.133 kPa), finger oxygen saturation 99% (without indoor oxygen). Heart rhythm, no murmur. Rales were not observed in auscultation of both lungs. The abdomen is soft without tenderness, and the intestinal sounds are normal. An ulcer is visible at the glans of the penis.

The 18-year-old male was admitted to the Department of Rheumatology of East China Hospital in May 2016 due to oral and vulvar ulcers and ophthalmia for more than 2 months. The patient's general condition is acceptable. Due to severe oral ulcer with pain, the body weight decreased by 2 kg due to a slight decrease in diet, and the nutritional status is acceptable. Slightly weak, no fever, physical examination: no abnormalities in the heart and lungs, no swollen lymph nodes palpable throughout the body. Blood and urine routine were normal, the sedimentation rate of erythrocytes was 16 mm/1 h, C-reactive protein was 1.64 mg/L, liver and kidney function and coagulation function were normal, protein electrophoresis showed: a1 globulin 8.26% (reference value 2.63-5.03), immunoglobulin E 315 000 U/L (reference value<100)。 The antinuclear antibody was slightly higher than 68.1 (reference value 0-55), and the remaining autoantibodies were all negative. Tuberculosis SPOT test (T-SPOT.TB), syphilis-specific antibody (ANTI-TP), hepatitis B marker and HIV were all negative. The diagnosis was considered Behcet's disease (Figure 1), because the patient is close to the national unified examination for enrollment in ordinary colleges and universities (hereinafter referred to as the college entrance examination), active treatment is given. Methylprednisolone 80 mg·dose^－1• d^－1Intravenous drip, cyclosporine A 75 mg/time, 2 times/d; Thalidomide 100 mg/bedtime; Total glycosides of paeony 0.6 g/time, 3 times/d; Local antibiotics, hormones and drugs to promote the growth of skin and mucosa are given for oral and vulvar ulcers, and fluorometrolone eye drops and diclofenac sodium eye drops are given for ophthalmitis. The patient did not improve significantly after 3 days of treatment, and was given etanercept 25 mg subcutaneous injection twice/week (2 times in total). The patient still did not improve significantly. He was discharged from the hospital because he was eager to take the college entrance examination, and the dose of thalidomide was reduced (to avoid neurological side effects) by 50 mg/bedtime; The rest of the oral medication was the same as during hospitalization.

Acute myocardial infarction (AMI) is a common cardiovascular emergency. AMI is also an important cause of intraventricular block. When AMI is combined with bundle branch block (BBB), it often indicates that the myocardial infarction is large, the prognosis is dangerous, and the mortality rate is significantly increased. Therefore, it has been paid more and more attention worldwide. However, debate remains regarding the relevant diagnostic criteria and treatment options.