This paper introduces professor WU Rongzu's clinical experience in using Fuyang Tongmi Decoction （扶阳通秘汤， FTD） to treat irritable bowel syndrome with constipation （IBS-C）. It is believed that yang qi depletion， water cold， earth dampness， and wood constraint are the key pathogenesis.The treatment principle is warming water， drying the earth and venting wood， with the basic formula FTD adjusted according to the symptoms. This approach aims to transport the qi movement of the middle jiao （焦） and support the recovery of intestinal function of directing turbidity downward， providing a treatment strategy for IBS-C caused by yang deficiency.

Objective:To summarize the consultation data from the department of rheumatology and clinical immunology of Peking Union Medical College Hospital, and to describe the distribution of consultation needs of different rheumatic and immunologic diseases (RID) in each unit.Methods:To collect and analyze the data of patients who accepted the consultations of rheumatology and clinical immunology of Peking Union Medical College Hospital from January 1, 2021 to December 31, 2021.Results:A total of 1 640 consultations were executed. The ratio of male-to-female was 556∶1 084, with an average age of (44.5±16.0)years. The proportion of single consultation was 57.26% (939/1 640) while that of twice and multiple consultation was 42.74% (701/1 640). Among the consultations, 87.56% (1 436/1 640) were routine ones, especially from emergency 25.21% (362/1 436), department of infectious diseases 12.88% (185/1 436) and cardiology 12.47% (179/1 436). The other 12.44% (204/1 640) were multi-disciplinary treatment (MDT), mainly in department of general internal medicine, emergency and obstetrics. Main purposes of consultation included 52.66% (514/976) for RID condition assessment/medication adjustment and 47.34% (462/976) for etiological diagnosis in internal medicine unit; while 55.77% (58/104) for guidance for perioperative RID treatment in surgery. In Obstetrics and Gynecology, the majority purposes were RID condition assessment/medication adjustment 36.36% (12/33), perioperative treatment guidance 27.27% (9/33) and surgical risk/timing assessment 27.27% (9/33). Most consultations were focused on SLE, UCTD, SS, RA and TA.Conclusion:Requested as MDT and multiple repeat,consultation needs for department of rheumatology and clinical immunology are great, especially from emergency and infectious disease unit. It may improve the efficacy of consultation by popularizing the meaning of autoantibodies and enhancing the awarness of common RID and its complications, as well as the awareness of perioperative and prenatel periods.

Objective:To summarize the consultation data from the department of rheumatology and clinical immunology of Peking Union Medical College Hospital, and to describe the distribution of consultation needs of different rheumatic and immunologic diseases (RID) in each unit.Methods:To collect and analyze the data of patients who accepted the consultations of rheumatology and clinical immunology of Peking Union Medical College Hospital from January 1, 2021 to December 31, 2021.Results:A total of 1 640 consultations were executed. The ratio of male-to-female was 556∶1 084, with an average age of (44.5±16.0)years. The proportion of single consultation was 57.26% (939/1 640) while that of twice and multiple consultation was 42.74% (701/1 640). Among the consultations, 87.56% (1 436/1 640) were routine ones, especially from emergency 25.21% (362/1 436), department of infectious diseases 12.88% (185/1 436) and cardiology 12.47% (179/1 436). The other 12.44% (204/1 640) were multi-disciplinary treatment (MDT), mainly in department of general internal medicine, emergency and obstetrics. Main purposes of consultation included 52.66% (514/976) for RID condition assessment/medication adjustment and 47.34% (462/976) for etiological diagnosis in internal medicine unit; while 55.77% (58/104) for guidance for perioperative RID treatment in surgery. In Obstetrics and Gynecology, the majority purposes were RID condition assessment/medication adjustment 36.36% (12/33), perioperative treatment guidance 27.27% (9/33) and surgical risk/timing assessment 27.27% (9/33). Most consultations were focused on SLE, UCTD, SS, RA and TA.Conclusion:Requested as MDT and multiple repeat,consultation needs for department of rheumatology and clinical immunology are great, especially from emergency and infectious disease unit. It may improve the efficacy of consultation by popularizing the meaning of autoantibodies and enhancing the awarness of common RID and its complications, as well as the awareness of perioperative and prenatel periods.

Lateral Ligament, Ankle/injuries* ; Ankle Joint

Objective:To analyze the clinical characteristics of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods:A retrospective study was conducted on AAV patients with long-term follow-up in the rheumatology outpatient clinic of Peking Union Medical College Hospital between February 2015 and February 2022. The demographic characteristics, clinical manifestations, concurrent events, treatment, and prognosis of the three clinical subtypes of AAV were collected and analyzed.Results:There were 71, 45, and 31 cases of granulomatous polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatous polyangiitis (EGPA), respectively, among 147 patients. The ANCA positivity rates in the three groups were 91.5%, 95.6%, and 19.4% ( χ2=76.68, P<0.01), respectively. The upper respiratory tract and lungs were the most frequently affected organs in GPA and EGPA, and the kidneys and lower respiratory tract were the main organs involved in MPA. In addition, cardiac and neurological involvement and thrombosis rates were significantly higher in EGPA patients than in GPA and MPA (12.9%, 9.7%, 41.9% and 19.4%, respectively; χ2=8.51、7.13、7.54、0.02, P<0.05) .The median follow-up time for the three groups of patients was 43, 28, and 46 months respectively.Relapse was more common in patients with GPA and EGPA (up to 59.2% and 64.5%; χ2=11.26, P=0.004), with the lungs and ENT being the most common relapse organs (GPA of 61.9% and 40.5%, EGPA of 55.0% and 50.0%), the lungs and kidneys were the most common manifestations in MPA relapse (64.3% and 60.0%, respectively). The main therapeutic agents were glucocortoid (95.9%), cyclophosphamide (71.4%), methotrexate (54.4%), tripterygium wilfordiz (34.0%),mycophenolate mofetil (31.3%), azathioprine (29.3%), leflunomide (19.0%), rituximab (19.0%), and tacrolimus/cyclosporine (8.8%). There were 6 deaths (4.1%) occurred during the follow-up period of this study. Conclusion:The clinical features of AAV are similar to those reported in the literature and relapses are common>he vast majority of patients need to be treated with glucocorticoid combined with immunosuppressive agents.

Restoration of teeth after removal of previous restorations is a common problem in the dental clinic. The situation of teeth after removal of previous restoration is complex and often requires multidisciplinary cooperation. However, there is a lack of systematic and concise guidelines for determining the treatment plan for those teeth. Through a combination of restorative clinical experience and the opinions of endodontic specialists, the author systematically described the problems that may exist after the removal of previous restorations in the teeth that have not undergone or have undergone root canal treatment (RCT) and those with post and core restorations. And summarized the corresponding treatment recommendations according to their pulpal and periapical status, the quality of RCT and the presence or absence of post and core restorations. ①For teeth without RCT, the vitality of the pulp, the occurrence of pulpal/periapical disease and the amount of re-preparation need to be assessed to determine whether RCT is necessary. ②For teeth with RCT, if the quality of RCT is good and no periradicular lesion exists, direct restorative treatment can be considered. If the quality of the RCT is unsatisfactory but no periradicular lesion exists, root canal retreatent (re-RCT), follow up or direct restorative treatment should be performed as appropriate and treatment plan can be developed in conjunction with the endodontist if necessary. If the quality of the RCT is unsatisfactory and periradicular lesion exists, re-RCT is necessary before restorative treatment.③For teeth with post and core restorations, if the quality of RCT is good and no periradicular lesion exists, direct restorative treatment can be considered. If the quality of the RCT is unsatisfactory but no periradicular lesion exists, follow up or direct restorative treatment should be performed as appropriate and treatment plan can be developed in conjunction with the endodontist if necessary. If the quality of RCT is unsatisfactory and periradicular lesion exists, for teeth with thin post and thick root canal walls, re-RCT after removal of the post can be attempted. For teeth with thick post and thin root canal walls, preservation of the post and apical surgery can be considered. For the teeth with excessively large defects or extremely poor periodontal conditions, extraction is recommended. The author refined the above recommendations into a set of treatment procedures, aiming to provide a reference for the selection of treatment options for teeth after removal of previous restorations.

Objective:To evaluate the efficacy and safety of rituximab(RTX) as remission-mainten-ance therapy in antineutrophil cytoplasmic antibody(ANCA) associated vasculitis(AAV).Methods:Patients with AAV, including granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), treated with rituximab (RTX) in Peking Union Medical College Hospital during September 2005 to June 2021 were included into this study. Clinical data, relapse rate, time of first relapse and adverse events were collected and analyzed. The cumulative relapse rate was calculated by Kaplan-Meier, t test, and Man-Whithey U test and chi-square were used to compare differences between two groups. Results:① Thirty-nine AAV patients were enrolled, including 36 GPA and 3 MPA. During the 20(3, 104) months follow-up, 59.0%(23/39) patients had suffered relapses. The time for first relapse was 11(3, 42) months after remission. ② There were no difference in the relapse rate [60.0%(18/30) vs 55.6%(5/9), χ2=0.06, P=1.000), the time of first relapse [15(3, 42) vs 10(9, 30), Z=0.45, P=0.678], CD19 + B [23.5 (5, 148) cell/μl vs 3(2, 15) cell/μl, Z=0.57, P=0.605] and serum IgG [7.09(5.13, 13.90) g/L vs 9.72(5.32, 12.0) g/L, Z=0.36, P=0.770] between standard dose and low-dose groups. The rate of major relapse-free was significantly less in patients treated with standard dose than patients with reduced dose of RTX {87.1%[95% CI(73.4%, 100.8R%)] vs 64.3%[95% CI(23.1%, 105.4%)], χ2=7.59, P=0.006}. ③ There were no difference in relapse rate [50.0%(3/6) vs 60.6%(20/33), χ2=0.24, P=0.674], time of first relapse [23(6, 25) vs 11(3, 42), Z=0.05, P=0.982], CD19 + B[35(15, 50) cell/μl vs 10(0, 148) cell/μl, Z=0.95, P=0.382] and serum IgG[6.70(5.91, 7.49) g/L vs 7.69(3.78, 13.90) g/L, Z=0.48, P=0.700] between the fixed interval dosage and the on-demand dosage groups. There was no difference in the rate of major relapse-free between the two groups (100% vs 77.8%, χ2=1.79, P=0.181). ④ The incidence of infusion reaction was 5.1%(2/39) and infection was 20.5%(8/39). Serum IgG level was 4.37(3.78, 13.4) g/L at infection. There was no difference in safety between the standard and low-dose groups or between fixed interval and on-demand dosage groups ( P>0.05). Conclusion:There is no significant difference in relapse rate bet-ween the standard RTX dose and low-dose RTX induction therapy group, but the major relapse rate is sign-ificantly reduced in the standard dose RTX therapy. The relapse rate of fixed intervals dosage group is similar to that of on-demand dosage group. The safety profile of the standard dose and low-dose induction therapy groups or fixed intervals and on-demand dosage groups is similiar.

One 51 years old man was admitted to the rheumatology department with a history of prominent eyes, headache and blurred vision for half year. The main manifestations included retrobulbar inflammatory pseudotumor and retroperitoneal fibrosis. He was initially diagnosed as granulomatosis with polyangiitis. Prednisone and cyclophosphamide were administrated and effective. New mass of dura mater and osteosclerosis presented during follow up. Finally Erdheim Chester disease(ECD) was diagnosed by biopsy and pathological examination. Vemurafenib, a v-raf murine sarcoma viral oncogenes homolog B1 (BRAF) inhibitor, 480 mg was given twice a day. The patient′s condition is stable and still in follow-up. Although ECD is a rare histiocytosis, clinicians should pay attention to its manifestations and differential diagnoses.

Objective:To explore the efficacy and safety of anti-tumor necrosis factor alpha (TNFα) monoclonal antibodies (mAbs) for severe/refractory vasculo-Behcet′s disease (BD).Method:The clinical data of severe/refractory vasculo-BD patients treated with anti-TNFα mAbs were retrospectively analyzed. Response of anti TNFα mAbs was analyzed. The dosage changes of glucocorticoid, the level of erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hsCRP) before and after treatment were recorded, as well as side effects.Result:Sixteen patients were enrolled. Arterial lesions were reported in 12 patients, including 9 with arterial aneurysm, 6 with arterial dilation, 2 with stenosis and 2 with occlusion. Seven patients presented venous thrombosis, including lower extremity veins ( n=6), cerebral venous sinus ( n=2) and inferior vena cava system ( n=2). Two cases had both arterial and venous involvement. Before the application of TNFα mAbs, all 16 patients failed to response to prednisone or its equivalent dose of 40 (7.5-90) mg/d in combination with cyclophosphamide, methotrexate, thalidomide or azathioprine for median 4 (0-156) months. After a mean duration of treatment for (17.1±6.5) months, 15 patients achieved complete remission and 1 patient achieved partial remission. Three patients received surgery without any postoperative complications. After using anti TNFα mAbs, the dosage of prednisone [5(0-12.5)mg/d vs. 40(7.5-90)mg/d, P<0.01], ESR [(7.3±4.6) mm/1h vs. (33.5±26.7) mm/1h, P<0.01] and hsCRP [1.9(0.2-11.4) mg/L vs. 24.3(0.4-113.9) mg/L, P<0.01] were significantly decreased. Side effects were observed in 2 patients. One developed pulmonary infection 12 months after adalimumab with conventional treatment. Another patient had allergy to infliximab then switched to adalimumab. Conclusion:In combination with corticosteroids and immunosuppressants, anti-TNF α mAbs are effective and well-tolerated in severe/refractory vasculo-BD, with a favorable steroid -sparing effect and rare postoperative complications.

Objective:To analyze the clinical and prognostic characteristics in patients with eosinophilic granulomatosis with polyangitis (EGPA).Methods:The clinical data of 146 EGPA patients hospitalized in Peking Union Medical College Hospital from 2000 to 2019 were analyzed retrospectively, including clinical manifestations, laboratory results, treatment, complications and outcome at discharge. Birmingham Vasculitis activity score-V3 (BVAS-V3) was used to evaluate disease activity.Results:The ratio of male to female was 1.8∶1 with average age (41.7±16.1) year-old. The median time from disease onset to diagnosis was 18(6, 60) months (0.5~450). The most common clinical manifestations were lung [121(82.9%)] and nose/paranasal sinuses [119(81.5%)] involvement. The positive rate of anti-neutrophil cytoplasmic antibody (ANCA) was 24.7%, mainly peripheral (P)-ANCA/myeloperoxidase (MPO)-ANCA. Compared with ANCA-negative patients, the ANCA-positive patients had a higher incidence of renal involvement and nervous system involvement (66.7% vs. 20.9%, 80.6% vs. 51.8%, P<0.001), fever and optic neuropathy (66.7% vs. 40.9%,8.3% vs. 0, P<0.05), more active disease [median BVAS-V3 25(18,30)vs. 19(14,24), P=0.001] and more elevated erythrocyte sedimentation rate [40.5(20.5,82.8)mm/1h vs. 25.0(13.3,50.8)mm/1h, P=0.006] and C-reactive protein [37.1(11.8,72.9)mg/L vs.13.5(3.4,66.1)mg/L, P=0.036]. More ANCA-negative patients had pleural effusion (20.9% vs. 5.6%, P<0.04) compared with ANCA-negative patients. Pulmonary infection was the most common complication. A total of 12 EGPA patients (8.2%)achieved remission and 6 patients (4.1%)died or discharged themselves from the hospital. Conclusion:EGPA is a rare small vessel vasculitis. The clinical manifestations and outcomes are heterogenous. The mortality rate of EGPA is high.