A middle-aged male came to Peking Union Medical College Hospital for treatment because of "pain for 10+ years, aggravated with emotional instability for 5 years". The patient's pain had a huge impact on life, with poor results even after repeated diagnosis and treatment in other hospitals. After multi-disciplinary discussion, it had been clarified that the pain was mainly caused by gout. The disease was heavily influenced by psychosocial factors. Therefore, the patient fits the diagnosis of "Psychological and Behavioral Factors Affecting Physical Diseases". The multi-disciplinary comprehensive management of the patient was carried out to identify and treat psychological factors affecting other medical conditions. After this mental treatment was performed, the patient's conditions significantly improved. The diagnosis and treatment of this patient demonstrates the importance of the multi-disciplinary treatment team for somatic symptoms (disorders).

Humans ; Tacrolimus/therapeutic use* ; Lupus Erythematosus, Systemic/drug therapy* ; Immunosuppressive Agents/therapeutic use* ; Treatment Outcome

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 investigate the clinical characteristics, diagnosis, treatment and prognosis of therapy-related myeloid neoplasms (t-MNs) after successful treatment for acute promyelocytic leukemia (APL) . Methods: Clinical data of 4 patients, diagnosed as t-MNs secondary to APL at Hematology Hospital of Chinese Academy of Medical Sciences from October 2012 to January 2019, were collected retrospectively. T-MNs related literature was reviewed. Results: The 4 cases were all females, with the median age 42 (range 40-53) years old at the diagnosis of APL. Regarding the induction and consolidation regimens, 3 patients received all-trans retinoid acid (ATRA) and arsenic trioxide (ATO) combined with anthracycline/anthraquinone and/or cytosine. One patient only received ATRA and other auxiliary drugs. Alkylating agents were not administrated. The 4 patients developed t-MNs 40 to 43 months after complete remission (CR) of APL, including 1 case of therapy-related myelodysplastic syndrome (t-MDS) and 3 cases of acute myeloid leukemia (t-AML) . The PML-RARα fusion genes were all negative when t-MNs developed. The three patients with t-AML were treated with 3 to 4 re-induction regimens, one of whom underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after complete remission (CR) . One patient with t-MDS received hypomethylating agents. After a median follow-up of 54.5 (48-62) months, 2 patients with t-AML died, the median overall survival after t-MN was 12 (5-18) months. From 1989 to 2018, a total of 63 t-MN cases were reported in the literature. Therefore, 67 cases were analyzed when four patients in our center were added, including 27 males and 40 females with median age 52.5 (15-76) years. The median latency was 39 (12-126) months and the median overall survival after diagnosis of t-MN was 10 (1-39) months. Conclusions Although rare, t-MNs may occur after successful control of APL. There are no existing guidelines for prevention and treatment of t-MNs, which have very poor prognosis. If cytopenia or other abnormalities of peripheral blood cells develop after 3 years of APL, t-MNs should be considered as a differential diagnosis.

Objective To explore the use of biological agents in Neuro-Beh(c)et's disease (NBD).Methods We retrospectively reviewed the clinical data of five NBD patients treated with biological agents who were in-patients at Peking Union Medical College Hospital between June 2009 and June 2016.The continuous variables were analyzed by t test.Results All five cases (4 male and 1 female) were severe and/or refractory patients with parenchymal involvement (pNBD).Their age at neurological onset was (31±12) years old.Four cases presented with multiple lesions.The brainstem,spinal cord,cerebral hemisphere and cerebellum involvement were presented in 4,3,3 and 2 patients,respectively.The Rankin score at the onset of NBD was (4.0±0.7).The biological agents were administrated when corticosteroids and immunosuppressant were ineffective.Three cases received tumor necrosis factor (TNF)-α inhibitors therapy,among whom one patient had gastrointestinal ulceration.One patient with refractory retinal vasculitis received interferon-α therapy.One patient treated with tocilizumab [interleukin (IL)-6R inhibitor] had high level IL-6 in the cerebrospinal fluid.All patients achievcd clinical improvements and the Rankin score significantly decreased to (2.2±0.8) when compared with the baseline (t=4.81,P＜0.01) after the treatment with biological agents.The corticosteroid dose was tapered in all cases and the numbers of immunosuppressants were reduced in most cases,indicating a potential steroid and immunosup-pressant-sparing effect.No serious adverse events were observed during the follow-up.Conclusion Neurological involvement is a severe complication of Behqet's disease.We can take appropriate biological agents such as TNF-α inhibitors or interferon-α into consideration when patients have severe/refractory pNBD.

Objective To study and investigate the changes of serum VEGF,EGF,EPO,TPO and oxidative stress of patients with aplastic anemia.Methods A total of 54 patients with aplastic anemia were selected as observation group,and 54 healthy people were selected as control group.The serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes of two groups were detected and compared,and the serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes were compared in patients with different Camitta types and classifications in the observation group.The relationship between those serum indexes and patients with aplastic anemia were analyzed by the Logistic analysis.Results The serum VEGF and EGF levels of observation group were significantly lower than those of control group,while the serum EPO and TPO levels were significantly higher than those of control group,the serum enzymatic antioxidant indexes including TAC,SOD and CAT of observation group were significantly lower than those of control group,serum MDA was significantly higher than that of control group,serum non-enzymatic antioxidant indexes including MT,GSH,Zn and Se were significantly lower than those of control group,serum Cu was significantly higher than that of control group,and the serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes of observation group with different Camitta types all had significant differences,and those serum indexes all had close relationship with the aplastic anemia (P ＜ 0.05).Conclusion The serum VEGF,EGF,EPO,TPO and oxidative stress of patients with aplastic anemia are in abnormal state,and these indexes all have close relationship with the disease.

Objective To investigate the relationship between the serum high mobility group box-1 protein (HMGB1),prostaglandin E2 (PGE2),vasculaRendothelial growth factoR(VEGF),interleukin (IL) and acute lymphoblastic leukemia.Methods A total of 68 patients with acute lymphoblastic leukemia were selected as observation group,and 68 healthy people at the same time were selected as control group.The serum HMGB1,PGE2,VEGF and IL levels of two groups were detected and compared,the serum detection results of patients with different stages and types of acute lymphoblastic leukemia were compared in the observation group,and the relationship between those serum indexes and acute lymphoblastic leukemia was analyzed by the Logistic analysis.Results The serum HMGB1,PGE2,VEGF and IL levels of observation group were significantly higheRthan those of the control group,and the serum detection results of patients with different stages and types of acute lymphoblastic leukemia had significant differences in the observation group.Logistic analysis showed that the serum HMGB1,PGE2,VEGF and IL were closely correlated with acute lymphoblastic leukemia (P<0.05).Conclusion The serum HMGB1,PGE2,VEGF and IL of patients with acute lymphoblastic leukemia are in high expression state,and there are significant differences in patients with different stages and types.

Objective To study and investigate the changes of serum VEGF,EGF,EPO,TPO and oxidative stress of patients with aplastic anemia.Methods A total of 54 patients with aplastic anemia were selected as observation group,and 54 healthy people were selected as control group.The serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes of two groups were detected and compared,and the serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes were compared in patients with different Camitta types and classifications in the observation group.The relationship between those serum indexes and patients with aplastic anemia were analyzed by the Logistic analysis.Results The serum VEGF and EGF levels of observation group were significantly lower than those of control group,while the serum EPO and TPO levels were significantly higher than those of control group,the serum enzymatic antioxidant indexes including TAC,SOD and CAT of observation group were significantly lower than those of control group,serum MDA was significantly higher than that of control group,serum non-enzymatic antioxidant indexes including MT,GSH,Zn and Se were significantly lower than those of control group,serum Cu was significantly higher than that of control group,and the serum VEGF,EGF,EPO,TPO,enzymatic antioxidant indexes and non-enzymatic antioxidant indexes of observation group with different Camitta types all had significant differences,and those serum indexes all had close relationship with the aplastic anemia (P ＜ 0.05).Conclusion The serum VEGF,EGF,EPO,TPO and oxidative stress of patients with aplastic anemia are in abnormal state,and these indexes all have close relationship with the disease.

Objective To investigate the relationship between the serum high mobility group box-1 protein (HMGB1),prostaglandin E2 (PGE2),vasculaRendothelial growth factoR(VEGF),interleukin (IL) and acute lymphoblastic leukemia.Methods A total of 68 patients with acute lymphoblastic leukemia were selected as observation group,and 68 healthy people at the same time were selected as control group.The serum HMGB1,PGE2,VEGF and IL levels of two groups were detected and compared,the serum detection results of patients with different stages and types of acute lymphoblastic leukemia were compared in the observation group,and the relationship between those serum indexes and acute lymphoblastic leukemia was analyzed by the Logistic analysis.Results The serum HMGB1,PGE2,VEGF and IL levels of observation group were significantly higheRthan those of the control group,and the serum detection results of patients with different stages and types of acute lymphoblastic leukemia had significant differences in the observation group.Logistic analysis showed that the serum HMGB1,PGE2,VEGF and IL were closely correlated with acute lymphoblastic leukemia (P<0.05).Conclusion The serum HMGB1,PGE2,VEGF and IL of patients with acute lymphoblastic leukemia are in high expression state,and there are significant differences in patients with different stages and types.