Volume 97  ·  Issue 41  ·  2017

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]。

To evaluated the outcome of prevention and treatment for glucocorticoid-induced osteonecrosis of femoral head with anticoagulant and vasodilator drugs.

A prospective, randomized, double-blind study was performed. From August 2003 to August 2006, 58 patients with large amounts of hormone therapy in the Zhongshan Hospital Affiliated Dalian University were enrolled and randomly assigned to the control group (placebo) or preventive group (anticoagulant and vasodilator drugs). And we prospectively analyzed the clinical outcomes of 24 patients with glucocorticoid-induced osteonecrosis of femoral head early stage (treatment group)treated by anticoagulant and vasodilator drugsat the same time. Disease incidence rate and progression were evaluated by radiography and magnetic resonance imaging (MRI), Follow-up of patients with femoral head survival curve was drawn. The Harris Hip Score and the Short Form 36 health survey were used to rate hip function and quality of life, respectively.

Thus, a total of 80 patients were assessed in this study, 24 cases in control group[follow up from 7.5 to 13.0(10.7±1.6)years], 22 cases in preventive group and 24 cases in treatment group. There was significant difference in theincidence rate of Osteonecrosis of femoral head, survive rate of femoral head and HHS score between the control groupand preventive group(41.7% vs 13.6%, 66.7% vs 70.8% , P<0.01).

Anticoagulant and vasodilator drugs could effect on preventing theglucocorticoid-induced osteonecrosis of femoral head, reducing disease progression, or improving life quality.

To explore the influences on peri-operative blood loss and postoperative blood transfusion in primary total knee arthroplasty when using different methods to release the pneumatic tourniquet.

From January 2015 to December 2016, 484 patients with osteoarthritis were enrolled, undergoing primary unilateral total knee arthroplasty in the Orthopedics Department of Peking University Third Hospital. Retrospective data was used, and all the patients had been operated on by three independent working groups. Group A was the strategic tourniquet release group. After the completion of all osteotomy and soft tissue balance, the tourniquet was released for five minutes for coagulation of bleeding tissue and was then inflated again before component cementation untill the end of the operation. In Group B, full-time tourniquet usage was applied to patients, and was just released post wound closure and pressure dressing. In Group C, the tourniquet was inflated from the beginning of incision to the end of cementation. It was then released after the prosthesis was cemented. A series of data in these three groups were observed and recorded, including output of drain, decrease of hemoglobin level in the first and third day after operation, the total measured blood loss, the hidden blood loss, the number of transfused patients, and the rates of allogenic blood transfusion.

The decrease of hemoglobin level in the first day after operation, the output of drain and the total level of measured blood loss were slightly higher in Group A. The decrease of hemoglobin level in the third day after operation and the hidden blood loss was slightly higher in Group B. Group C had the lowest total measured blood loss and hidden blood loss among the three groups. However, no significant differences of outcomes were observed among these groups. A total of 29 patients received blood transfusion(Group A 10/165, 6.1%; Group B 11/177, 6.2%; Group C 8/142, 5.6%). There was no significant differences among the three groups in output of drain(P=0.496), decrease of hemoglobin level(P=0.242), total measured blood loss(P=0.390), hidden blood loss(P=0.204), or postoperative blood transfusion rate(P=0.976).

Under the routine application of the multimodal blood-loss prevention approach, including tranexamic acid, drain under atmospheric pressure, compression and cryotherapy after operation, the different choices of tourniquet releasing strategies have no significant effect on peri-operative blood loss or postoperative blood transfusion rate in total knee arthroplasty.

To investigate the tibial baseplate coverage with symmnetrical tibial prosthesis in primary total knee arthroplasty (TKA).

From August 2014 to February 2015, 39 patients (39 knees) with varus knee osteoarthritis were retrospective reviewed in Department of Orthopaedics, Tianjin Xiqing Hospital. Nine males and 30 females; aged 50 to 78 years (67±6 year). 3D tibia models of the knee were built with Mimics 10.01 software, simulated TKA surgeries were performed. The morphology of the proximal tibia was measured, including the mediolateral (ML), anteroposterior (AP) and medial and lateral tibial plateau AP dimensions. 3D models of PFC Sigma tibial prosthesis were imported and the tibial coverage characters were analyzed.

The AP and ML dimensions of the tibial resection surface were (45.7± 3.4) mm, (71.7± 4.2) mm respectively, the plateau aspect ration ratio (AP/ML) was 63.8%±3.0%. The medial tibial plateau AP[(46.9± 3.3) mm]was significantly greater than the lateral side[(41.8±3.3) mm, P=0.000], the asymmetric ratio averaged 112.4%±6.9%. The medial tibial plateau, anteromedial, posteromedial, posterolateral unsatisfied coverage ratio were 33.3%, 76.9%, 20.5%, 33.3% respectively. There are 5 cases underhang and 3 cases overhang in the posteromedial side, whereas 1 case underhang and 12 cases overhang posterolateral, the overhang ratio was 30.8%. Posteromedial, posterolateral prosthesis coverage had linear positive correlation to the ipsilateral tibial plateau AP diameter.

The medial AP diameter of tibial plateau is significantly lager than the lateral side in varus knee osteoarthritis patients. With symmetrical tibial baseplate placement in TKA, the prosthesis usually lead to medial tibial plateau anterior and posterior underhang and posterolateral overhang.

To evaluate the clinical efficacy of Total hip arthroplasty (THA) in treating the hip joint involvement of Psoriatic arthritis (PsA).

From January 2005 to December 2016, a total of 15 PsA patients (20 hip joints) underwent THA in Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. All the patients had obvious restriction in daily life before operation. The mean Harris score was 25.2 averagely and the mean total range of the hip joint movement was 39.6° before surgery. All the prosthesis were biotype and ceramic to ceramic.

All patients were followed up with an average of 35.7 months and could take care of themselves. The Harris score of hip joint was 83.2 averagely, including 15 hips excellent, 3 good, and 2 passable, with an excellent and good rate of 90%. The mean total range of the hip joint movement was 175° after surgery. There was no infection, nerve injury or loosening of the prosthesis. 1 hip appeared avulsion fracture of greater trochanter of femur, and the joint function was satisfying at the last time of follow-up.

THA is an effective method in treating affected hip joint of PsA. It can restore the hip function and improve the life quality of the PsA patients.

To investigate the preventive effect, possible mechanism and safety of probucol on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD).

A total of 641 patients with coronary heart disease were consecutively enrolled from Department of Cardiology, in Tianjin Chest Hospital, Tianjin TEDA International Cardiovascular Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital. They were randomly divided into probucol group (n=321) and control group (n=320). The probucol group was given oral probucol 500 mg twice daily for day 0 to day 3 after PCI; the control group was given only conventional therapy. All patients were given intravenous drip 0.9% sodium chloride solution before 12 to 24 hours of operation. The levels of serum creatinine (Scr), blood urea nitrogen (BUN), evaluate glomerular filtration rate (eGFR), cystatin C (Cys-C), and high-sensitivity C-reactive protein (hs-CRP), neutrophil gelatinase associated lipocalin (NGAL), superoxide dismutase (SOD) and glutathione (GSH) were measured before and 72 h after the PCI operation in both groups. The incidence rates of CIN, the adverse events during hospitalization and postoperative 14-day follow-up were recorded in two groups.

There was no statistically significantly difference in the levels of Scr, BUN, eGFR, Cys-C, hs-CRP, NGAL, SOD and GSH between the two groups before PCI (P>0.05). The levels of serum Scr, BUN, Cys-C, hs-CRP, NGAL, SOD and GSH after operation in the two groups were higher than those before the operation (P<0.05). The levels of hs-CRP and NGAL in the probucol group were lower than those in the control group [(10±4) vs (11±4)mg/L, (25±8)vs (34±7)U/ml,P<0.05]. The levels of eGFR, SOD and GSH in probucol group were higher than those in control group [(80±27) vs (72±26) ml·min^-1·1.73 m^-2, (67±9) vs (58±8)U/ml, (4.6±0.9) vs (3.9±0.8)U/ml, P<0.05]. The incidence of CIN was 4.0% in the probucol group and 10.9% in the control group, and the difference was statistically significant (P<0.05, χ²=-3.31). Multivariate Logistic regression analysis showed that probucol was an independent protective factor for CIN (OR=0.334, 95%CI 0.172-0.648, P=0.001). There were no adverse events such as myasthenia gravis, abnormal liver function and cardiovascular events during the hospitalization and 14-day follow-up.

Probucol can reduce the incidence of contrast-induced nephropathy after PCI. The protection mechanism is related with its anti-inflammatory and anti-oxidative stress effects, and it has good safety.

To explore the psychological features and quality of life in outpatients with somatic symptoms disorder in a general hospital.

This cross-sectional study was conducted from 2014-05 to 2015-06. Patients diagnosed with major depressive disorder (MDD) and somatic symptoms disorder (SSD) were recruited from psychological outpatient department, and patients with peptic ulcer (PU) / reflux esophagitis (RE) were recruited from Gastroenterology. Depression scale of the patient health questionnaire (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), Toronto Alexithymia scale (TAS), 12-item Short Form Health Survey (SF-12), items from Somatoform Disorder Screening Questionnaire were employed to evaluate the severity of depression, anxiety, alexithymia, quality of life, health care use and subjective feelings.

Scores of PHQ-9 (10±6), GAD-7 (8±5), TAS (74±7) in patients with SSD were significantly higher than PU/RE patients (5±4, 5±4, 71±8, respectively), and the physical component summary (PCS) (40±8) and mental component summary (MCS) (37±10) of SSD patients were much lower than PU/RE (PCS 45±6, MCS 47±9) (P<0.01). No significant difference was found in the scores of PHQ-9, GAD-7, MCS-12, TAS between SSD and MDD group, but PCS-12 score of SSD group was much lower than that of MDD (P=0.017). Patients of SSD had more visits, more impact on life and longer duration of disorder. Multiple linear regression found that PHQ-9 score, subject feeling that life quality was affected were significant influential factors of PCS (F=14.600, P=0.001), and PHQ-9 score, occupation and ability to distinct emotion and physical feelings were significant influential factors of MCS (F=28.022, P=0.001).

The SSD patients in a general hospital suffer from somatic symptoms and emotional distress, and quality of life is affected significantly. Clinicians should thoroughly evaluate patients according to bio-psycho-social aspects and give intervention individually.

To investigate the features of apparent diffusion coefficient (ADC) histogram parameters based on entire tumor volume data in high resolution diffusion weighted imaging of nasopharyngeal carcinoma (NPC) and to evaluate its correlations with cancer stages.

This retrospective study included 154 cases of NPC patients[102 males and 52 females, mean age (48±11) years]who had received readout segmentation of long variable echo trains of MRI scan before radiation therapy. The area of tumor was delineated on each section of axial ADC maps to generate ADC histogram by using Image J. ADC histogram of entire tumor along with the histogram parameters-the tumor voxels, ADC_mean, ADC_25%, ADC_50%, ADC_75%, skewness and kurtosis were obtained by merging all sections with SPSS 22.0 software. Intra-observer repeatability was assessed by using intra-class correlation coefficients (ICC). The patients were subdivided into two groups according to cancer volume: small cancer group (<305 voxels, about 2 cm³) and large cancer group (≥2 cm³). The correlation between ADC histogram parameters and cancer stages was evaluated with Spearman test.

The ICC of measuring ADC histogram parameters of tumor voxels, ADC_mean, ADC_25%, ADC_50%, ADC_75%, skewness, kurtosis was 0.938, 0.861, 0.885, 0.838, 0.836, 0.358 and 0.456, respectively. The tumor voxels was positively correlated with T staging (r=0.368, P<0.05). There were significant differences in tumor voxels among patients with different T stages (K=22.306, P<0.05). There were significant differences in the ADC_mean, ADC_25%, ADC_50% among patients with different T stages in the small cancer group(K=8.409, 8.187, 8.699, all P<0.05), and the up-mentioned three indices were positively correlated with T staging (r=0.221, 0.209, 0.235, all P<0.05). Skewness and kurtosis differed significantly between the groups with different cancer volume(t=-2.987, Z=-3.770, both P<0.05).

The tumor volume, tissue uniformity of NPC are important factors affecting ADC and cancer stages, parameters of ADC histogram (ADC_mean, ADC_25%, ADC_50%) increases with T staging in NPC smaller than 2 cm³.

To investigate the effect of triple therapy with aspirin, prednisone and Elevit in patients with unexplained recurrent early pregnancy loss.

From January 1, 2013 to December 31, 2016, a total of 353 women of childbearing age were enrolled in Peking Union Medical College Hospital, including blood, urine and vaginal swabs. One hundred and fifty-five patients were observed normal results of blood test, urine test and vaginal swabs. According to the treatment regimen, 155 patients were divided into two groups, 89 patients (57.42%) treated with (aspirin, prednisone, and Elevit) as experimental group, and the other 66 cases (42.58%) taking folic acid as control group. The fetal bud, fetal heart and neck hyaline layer thickness were examined by ultrasonography at 12 weeks. Visible fetal bud, fetal heart, and nuchal translucency thickness <0.3 cm were used as indicators of successful treatment. t test and χ ² test were used to analyze and compare the statistical significance of the differences between the two groups of patients, and the Logistic method was used to analyze the data and observe the effect of medication.

There were 67 patients successfully treated in the experimental group, the successful rate was 83.75% (67/80), and 33 patients in the control group were successfully treated, the successful rate was 54.10% (33/61). There were significant statistical differences in two groups (P<0.05).

The effect of triple therapy with aspirin, prednisone and Elevit in patients with unexplained recurrent early pregnancy loss is significant.

To explore the effect of short-acting combined oral contraceptives on vaginal bleeding after induced abortion.

A total of 726 patients, who had took induced abortion from July 2016 to September 2016 in obstetrics and gynecology outpatient department of Nanfang Hospital, Southern Medical University, were included and divided into the observation group and the control group according to whether they took short-acting combined oral contraceptives after induced abortion, with 312 cases, 414 cases respectively.The vaginal bleeding days, amounts of bleeding, the endometrial thickness 3 weeks later, and whether the patient had menstrual recovery on time were observed and analyzed.

The observation group had less bleeding days and amount of bleeding, compared with the control group.69.87% (218/312) patients of the observation group had more than 8mm of endometrial thickness on postoperative day 21, while 61.11% (253/414) of the observation group did, the difference was statistically significant (P=0.034).90.06% (281/312) patients of the observation group had menstrual recovery on time, while 82.61% (342/414) of the observation group did, the difference was statistically significant (P=0.004).

Short-acting combined oral contraceptives after induced abortion can significantly shorten the vaginal bleeding days, reduce the amount of bleeding, promote endometrial repair and menstrual recovery.There fore, it has important clinical significance and application value.

To construct magnetic nanoparticles targeting β-amyloid (Aβ) plaques, the pathological biomarker of Alzheimer′s disease (AD) and to study their binding capability in vitro.

Superparamagnetic nanoparticles Mn_0.6Zn_0.4Fe₂O₄ (MZF) were coated with amphiphilic star-block copolymeric micelles and modified with Aβ-specific probe Pittsburgh compound B (PiB) to construct a novel magnetic nanoparticle MZF-PiB, which specifically targeted amyloid plaques. Transmission electron microscope was used to study the morphological features of MZF-PiB. Superparamagnetism of MZF-PiB was assessed by its r₂ relaxation rate by using 3.0 T MRI scanner. Cytotoxic test was applied to determine biosafety of MZF-PiB nanoparticles in differentiated human neuroblastoma cells (SH-SY5Y) and Madin-Darby canine kidney (MDCK). In vitro binding tests were conducted via immunohistochemistry on 6-month old AD mice brain sections. Differences of cell viability between groups were compared with one-way analysis of variance.

MZF-PiB nanoparticles were successfully constructed. Transmission electron microscope images showed that the nanoparticles were about 100 nm in size. The r₂ relaxation rate was 163.11 mMS^-1. No differences were found in cell viability of SH-SY5Y and MDCK incubated with MZF-PiB suspension for 24 h or 48 h when compared with those of untreated cells (F=2.336, 2.539, 0.293, 1.493, all P>0.05).In vitro binding tests indicated that the MZF-PiB were specifically bound to amyloid plaques. The smallest size of detected plaques was 27 μm.

PiB-modified nanoparticles targeting Aβ are biologically safe and highly superparamagnetic, possessing the capability to detect amyloid plaques earlyin vitro and the potential for early diagnosis of AD.

To investigate the mechanism of brain-derived neurotrophic factor (BDNF) promoting induced pluripotent stem cells (iPSCs) to differentiate into neural stem cells (NSCs) via Wnt/β-catenin and extracellular signal-regulated kinase/mitogen-activated protein kinases (ERK/MAPK) signal pathways.

iPSCs were cultured and identified. The iPSCs were induced to differentiate into NSCs by BDNF and retinoic acid (RA). Nestin was detected by immunofluorescence and flow cytometry after iPSCs differentiated. The technique of small interfering RNA (siRNA) was used to silence the gene expression of β-catenin and ERK, and iPSCs were divided into control group, BDNF group (adding 10 μg/L BDNF), siRNA-ERK/BDNF group (transfected with siRNA-ERK and adding 10 μg/L BDNF) and siRNA-β-catenin/BDNF group (transfected with siRNA-β-catenin and adding 10 μg/L BDNF). Real-time polymerase chain reaction (RT-PCR) and Western blotting were used to detect the mRNA and protein expression of key elements of Wnt/β-catenin and ERK/MAPK signaling pathways, included β-catenin, ERK1/2, c-fos, c-jun, and c-myc. The least significant difference test was used when data were compared between groups.

The immunofluorescence showed that iPSCs expressed octamer-binding transcription factor-4 (Oct4), SRY-related HMG box protein-2 (Sox2) and Nanog genes. The flow cytometry showed that Nestin-positive cells were 78.7% for BDNF and 43.5% for RA, and it was only 7.8% for routine medium. Compared with those in the control group, the mRNA expression of β-catenin, ERK1/2, c-fos, c-jun, and c-myc in the BDNF group were upregulated significantly ( t=2.80, 2.318, 2.255, 1.799, 1.582, 1.663, all P<0.05), and the same results were acquired with the protein expression (t=2.805, 2.318, 2.255, 1.799, 1.582, 1.663, all P<0.050). Compared with those in BDNF group, the mRNA and protein expression of ERK1/2 in siRNA-ERK/BDNF group down-regulated obviously (t=1.917, 2.042, 1.673, 1.540, all P<0.05), and the mRNA and protein expression of c-fos and c-jun were down-regulated (t=1.022, 0.907, 0.848, 0.801, all P<0.05). However, the mRNA and protein expression of β-catenin and c-myc were not suppressed by siRNA-ERK (t=0.216, 0.185, 0.097, 0.112, all P>0.05). In siRNA-β-catenin/BDNF group, the mRNA and protein expression of β-catenin and c-myc was obviously down-regulated when compared with those in BDNF group (t=3.104, 2.774, 2.235, 1.911, all P<0.05), and expression of ERK1/2, c-fos and c-jun were down-regulated too (t=0.776-1.192, all P<0.05).

BDNF promotes the differentiation of iPSCs by activating Wnt/β-catenin and ERK/MAPK signal pathway, there should be cross-talk between the two signal pathways, and c-fos and c-jun may be common nuclear transcription factors.

To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures.

A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis.

Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively (infection(I²=0%, RR=0.27, 95% CI 0.16-0.45, Z=4.92, P<0.000 01) and total complications(I²=0%, RR=0.71, 95% CI 0.59-0.85, Z=3.65, P=0.000 3) ), DASH scores(I²=37%, MD=-5.67, 95% CI -8.31--3.04, Z=4.22, P<0.000 1) and volar tilt(I²=78%, MD=2.29, 95% CI 0.33-4.24, Z=2.30, P=0.02)(P<0.05) at the end of follow-up period were noted. There were no statistically significant differences observed between two approaches with respect to the clinical outcomes (grip strength, flexion, extension, pronation, supination, radial deviation and ulnar deviation) and radiographic outcome(radial length) at the end of follow-up period(P<0.05).

Both open reduction and internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of volar tilt for treatment of distal radius fractures.

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.