Volume 90  ·   Issue 33  ·  2010

Adult flatfoot refers to other structural deformities such as flat foot appearance, low and flat medial longitudinal arch of foot or disappearance, full or flat foot heart, obvious bulge of scaphoid tubercle, accompanied by heel valgus, abduction of forefoot, mild subluxation of subtalar joint, lateral angulation of middle tarsal joint (talocaphoid and calcaneocaphoid joint), supination of forefoot relative to hindfoot and other structural deformities. The incidence rate is about 5% [1].

Objective To study the curative effect of operation to flatfoot deformity with concurrent spinal disease in children. Methods A retrospective survey was performed in 8 flatfoot patients with concurrent spinal disease from January 2004 to January 2008. Every case received special operative treatment. After casting, achilles tendon prolongation, reefing or tendon transfer, rehabilitation therapy was performed sequentially. Radiographs and clinical outcomes were evaluated during the follow-up. Results Six patients were followed up. There were 2 feet in 1 female and 7 feet in 5 males. The complications included tethered cord syndrome (n = 1 ), T12-S1 vertebral canal arachnoid cyst ( n = 1 ), cerebral palsy and scoliosis ( n = 1 ) and scoliosis and spinal bifada occult ( n = 3 ). The average age was 8.4 (4 - 14 ) years old and the average follow-up time 22 (14 -64) months. All cases were satisfied with the appearance and function according to Maryland foot score. Five were excellent, 2 good and 2 fair postoperatively versus 2 fair and 7 failed preoperatively. The total excellent and good rate was 77. 8%. In the early stage after tenden transfer in 4 patients, the lateral view of height arch, talus-first metatarsal angle, calcaneus navicular-first metatarsal angle and talonavicular coverage angle improved. Yet it lost the improved angle and reverted to the pre-operative state. No degenerative change was detected in tarsus joints during the long follow-up. Conclusion The special and sequential surgical procedure may be an effective regimen in the treatment of flatfoot deformity with concurrent spinal disease in children.

Objective To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction. Methods From 2005 to 2009, 10 patients ( 13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteetomy with mini-incision. The lateral skin incision of 3.0-4. 5cm was made to explore the lateral calcaneal wall Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3 - 1/2 width of calcaneal body and fixed by two parallelcannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI),talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot.Results With a mean postoperative follow-up period of 20. 3 months ( range 7-55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50. 3 to a mean of 80. 2 at 6 months and a mean of 84. 2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P ＜0. 001 ), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view. Conclusion The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.

Objective To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery. Methods Twenty-two patients ( 16 males, 6 females) with chronic achilles tendinitis were recruited. The average age was 33.5 years old ( range: 17-53). Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor.The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle: Type 1, hypertrophy (n = 10); Type 2, calcified tubercle (n = 5 ); Type 3, fiber tear (n = 7 ). All cases were treated with endoscopic debridement of ventral neovascularized area, poritendineum and Achilles tendon by shaver and radiofrequency (RF) probe.Resuits The patients were followed-up for a mean of 14 months (range: 9-15). Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded. Conclusion This scheme of classifying is helpful to the diagnosis and effective treatment of chronic Achilles tendonitis. With a high safety and a satisfactory efficacy, arthroscopic surgery has the advantages of minimally invasiveness.

Objective To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage ⅡB and Stage Ⅲ adult-acquired flatfoot. Methods The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage ⅡB adult-acquired flatfoot and 7 cases of stage Ⅲ adultacquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ),talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomied to restore their proper alignments. The optimal positioning of hindfoot could be gchieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses. Results All patients were followedup with a mean time of 13.2 (6-21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2. 6 postoperatively ( P ＜ 0.01 ). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied.Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle,lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported. Conclusion Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage ⅡB and Ⅲ adult-acquired flatfoot deformity. It may relieve pains,correct structural deformities and obtain excellent clinical outcomes.

Objective To explore the operative approach and efficacy of flatfoot after calcaneal fractures malunion. Methods A total of 116 flatfoot patients after old calcaneal fractures were treated from January 1998 to January 2008. There were 94 males and 22females with an average age of 33.5 years old (range: 16-46). They included unilateral flatfoot after old calcaneal fractures (n = 110) and bilateral flatfoot after old calcaneal fractures (n = 6). The surgical treatments included open reduction, calcaneal osteotomy without subtalar fusion or a reconstruction of calcaneal thalamus and subtalar arthrodesis. Results A total of 101 patients were followed up for an average of 14 months (range: 12 -24). No wound healing problem or infection was observed. Solid union was obtained without redislocation in all patients. The mean time of bone union was 12 weeks (range: 10 - 14). The mean time of oomplete weight loading was 13 weeks (range: 11 -15 weeks). The height of foot arch increased from 4.2 mm ±1.7 mm to 14.1 mm±4.1 mm( P ＜ 0.05). Calcaneal inclination angle increased from 11.2°± 2.5 ° to 19.1 °± 4.4° (p ＜ 0. 05 ). Bohler angle increased from 5.4°± 3.5° to 25.8°± 5.2° ( P ＜ 0.05). Meary angle recovered from 22.2°± 4.4° to 5.1°±3.2° (P＜0.05). The mean AOFAS Ankle and Hindfoot score increased from 33.4 (range: 27 -43) to 85.8 ( range: 78 - 98). Conclusion As to flatfoot after old calcaneal fractures, surgical treatment has a favorable efficacy. A customized operative approach may achieve a satisfactory outcome.

Objective To compare the analgesic efficacy of continuous femoral nerve blockade (CFNB) and continuous intravenous analgesia(CIA) after total knee arthroplasty(TKA). Methods 126 patients undergoing TKA under combined epidural-spinal anesthesia were randomized to receive either a femoral infusion of ropivacaine 0.2% (median infusion rate 5 ml/h) (n =63 ) or an intravenous infusion of fentanyl 30 μg/kg (2 ml/h) ( n = 63 ). Adjuvant analgesics were oral celebrex or IM pethidine. In the CFNB group, CFNB was established before combined epidural-spinal anesthesia and 20 ml 0. 5% ropivacaine was infused through the catheter placed near femoral nerve. Visual analogue scale ( VAS ) scores were assessed at rest and on passive mobilization by acute pain service blinded to analgesic treatment. Nausea and vomiting, dizziness, satisfaction and other side-effects were assessed postoperatively. Results There was significantly less VAS scores in the CFNB group comparing the CIA group at rest 4,8,12,16,24,36,48 hafter surgery(P ＜0. 01 ). A significant difference in VAS scores was found in CFNB group vs CIA group on passive mobilization 24,36,48 h after operation ( P ＜ 0. 01 ). There was significantly less dizziness, nausea and vomiting in the CFNB group ( P ＜ 0.01 ). Patient satisfaction was higher in the CFNB group ( 92.1%)than the CIA group(20. 6% ) (P ＜0. 01 ). Conclusion CFNA with ropivacainc 0. 2% is more effective in controlling postoperative pain than CIA and CFNB is an effective regional component of a multimodal analgesic strategy after TKA.

Objective To assess the clinical features in patients with cardiac valve lesions associated with Behcet's disease (BD). Methods We retrospectively reviewed the clinical data of 10 BD patients with cardiac valve lesions who were admitted to Peking Union Medical College Hospital (PUMCH)during June 1999 to June 2009. Results Aortic regurgitation occured in 6% of patients with BD in PUCMH. Patients included 8 male and 2 female with the mean age of 36.5. All the patients had occult onset cardiac symptoms with an average length of clinical course of 6 years. 5 patients fulfilled the ISG diagnostic criteria for BD and another 5 patients diagnosed by experts. The main echocardiography findings were severe aortic regurgitation, aneurysmal dilatations of ascendan aorta, echo-free space at the aortic root, aortic valve prolapse, meshlike mass incorporating aortic cusp, aortic valve perforation, et al. 3 patients underwent 7operations. 5 simple aortic valve replacement (AVR) surgeries resulted in severe perivalvular leakage. 2patients underwent Bentall and heart transplant surgeries respectively with perioperative immunosuppressive therapy had no complications. Conclusion Cardiac valve involvement in BD is a rare but critical problem that requires a timely diagnosis and management. The current diagnostic criteria may have possibilities of delayed diagnosis of such problem. Echocardiography seems to be helpful for the timely diagnosis. The immunosuppressive therapy and Bentall type operations may be essential for improving the treatment outcome of BD with cardiac valve lesions.

Objective To evaluate the value of four chamber view, outflow tract view and color Doppler echocardiosonography for detecting the fetal congenital heart defects among high-risk populations.And to discuss the significance of screening congenital heart defects by three methods and select the suitable method for wider applications. Methods The echocardiographic records of all pregnant women performed at our hospital from January 2006 to December 2007 were reviewed retrospectively by screening of clinical epidemiology. All cases received ultrasonic examinations. The abnormal cases with postnatal confirmation by echocardiogram or autopsy were included. The abnormalities detected in each view were analyzed and classified. Results A total of 52 fetuses with congenital heart defects were detected by gray scale sonography and color Doppler sonography in 1310 cases. Each specific cardiac defect had its typical finding in these three planes. The sensitivities of three methods were 61.5%, 88. 5% and 96. 1% respectively.Conclusion Four chamber view, outflow tract view and color Doppler sonography have played an important role in screening fetal common congenital heart defects. Outflow tract view is easy to operate and it may be recommended as a suitable method.

Objective To explore the fertilizing ability, cleavage potential and inheritance risks of globozoospermia. Methods A globozoospermic patient was diagnosed by sperm morphological staining and transmission electron microscope. From his wife the investigators obtained 26 oocytes in which 6 oocytes were donated and the other 19 ( in 20) MII oocytes injected into 19 round-headed sperms. Six donated oocytes accepted in vitro fertilization (IVF). This patient's chromosome and microdeletion in AZFa, AZFb and AZFc in Y chromosome were checked through 6 sequence tag sites of sY84, sY86, sY127, sY134, sY254 and sY255. Results Only 4 ( in 19) were normally fertilized and cleaved. All 6 donated oocytes were normally fertilized and cleaved. The fertilizing rate was significantly higher than that of this patient( 100% vs 21.1%,P ＜0. 01 ). But the cleavage rate has no statistical difference( 100% vs 100%, P ＞0. 05). This patient had normal chromosome (46, XY) and there was no deletion in Y chromosome. His wife became pregnant after accepting two thawed embryos and then gave birth to a boy whose chromosome was normal (46, XY). The acceptor also gave birth to a healthy boy after accepting two thawed embryos. Conclusions Despite a lower fertilizing rate, intracytoplasmic sperm injection is still an effective therapy for globozoospermic infertility.

：Objective To explore theapproach and efficacy of microsurgery for tuberculum sellae meningiomas. Methods Theclinical data of 56 patients with tuberculum sellae meningiomas treated at our departmentfrom 1991-2009 were analyzed retrospectively. There were 20 males and 36 females with anage range of 32-65 years old (mean: 46). All patients underwent microsurgery throughpterional, unilateral subfrontal, orbitozygomatic or supraorbital keyhole approach.Results Among these patients, there were total resection (n = 51 ) and subtotal resection(n = 5 ). Postoperatively, 53 patients recovered well, 2 had a mild disability, 1 suffereda severe disability and there was no mortality. Conclusion Most cases of tuberculum sellaemeningiomas can be removed safely and totally. Several approaches may be employed toachieve the best outcomes. Microsurgery can markedly boost the total resection rate oftuberculum sallae meningiomas and lower the postoperative complications and mortality.

Objective To review surgical outcomes in treating intracranial Giant arteriovenous malformations (AVMs). To find out the prognosis factors of surgical treatment. Methods We collected 46consecutive cases of giant AVMs treated at Beijing Tiantan Hospital, reviewed the radiological and SpetzlerMartin grading. 25 of the patients selected were male (54%), and 21 were female (46%), with a mean age of 30. 6. The major presenting symptoms were seizures, headaches, hemorrhage and neurological deficits. According to the Spetzler-Martin Grading, 8 patients were Grade Ⅲ, 22 were Grade Ⅳ, and 16were Grade Ⅴ. All patients received surgical treatment and postoperative DSA were performed. Clinical results and long term follow-up (KPS) were gathered for analysis. Results One of the 35 patients who received postoperative DSA revealed residual AVMs. Among all patients, severe complications were observed in 9 patients, and 1 patient died in the hospital. Complications included hemiparalysis ( 15 cases), aphasia (6 cases), hemianopia (9 cases), cranial nerve dysfunction (5 cases), and seizure (5 cases). Normal perfusion pressure breakthrough (NPPB) was observed in 6 patients. After 6-108 months of follow-up, 33of 37 survived follow-up patients presented normal function or minimal symptoms and ability to work or study, 4 patients died (2 were surgical-related). Conclusion Pre-surgical evaluation of every candidates and treatment choice are the determining factors in giant AVMs therapy. Microsurgery remains one of the most effective ways for eliminating giant cerebral AVMs, and the complication rate was acceptable. For giant cerebral AVMs located superficially or do not involve critical components, a good outcome can be expected through surgical resection.

Objective To evaluate the effect of surgical technique and clinical curative effect for a unilateral endonasal-transsphenoidal approach in the removal of pituitary adenomas (PAs) by an endoscopeassisted technique with sellar floor reconstruction. Methods Between April 2001 and March 2009, 426 consecutive patients underwent extended neuroendoscopic unilateral endonasal transsphenoidal surgery. The series consisted of 54( 12.7% ) as I type of Pas and 105 ( 24. 6% ) Ⅱ type, 181 (42. 5% ) Ⅲ type and 86 (20. 2% ) Ⅳ type according to Hardy's classification criteria of pituitary adenoma. Results Tumor removal,as assessed by intraoperative findings and postoperative magnetic resonance imaging or CT scans, revealed complete tumor removal in 370 cases (86. 9% )and subtotal tumor removal in 32 cases (7. 5% ) were achieved. Partial removal was carried out in the remaining 24 cases (5.6%) with fibrous tumor. Three patients (0. 7% ) had postoperative death in this group. Twenty-four patients (5. 6% ) had a postoperative cerebrospinal fluid leak that required repair operations. Six patients (1.4%) experienced a sphenoid mucositis and meningitis and they were cured by medical therapy. Conclusion The slightly soft texture of PAs with or without a limited suprasellar extension and without involvement of vascular structures, may be resected through such an extended neuroendoscopic transsphenoidal approach. Intraoperative angled endoscope is a useful adjunct for safe removals.

Objective To evaluate the formation mechanism and management of iatrogenic pseudoaneurysms of carotid and vertebral artery. Methods Four patients with iatrogenic pseudoaneurysms were identified at our department from April 2004 to February 2009 . One was caused by radiotherapy and the others due to surgical trauma. Two parents were treated with balloon occlusion of parent artery. Stent grafts were deployed in the other two patients to ensure the patency of parent arteries and occlusion of pseudoaneurysm. Results One patient with pseudoaneurysm of internal carotid artery developed decompensation after balloon occlusion. Unfortunately, long-term paralysis occurred after decompressive craniectomy. The other patients with vertebral artery pseudoaneurysm achieved an excellent outcome after balloon occlusion. The therapeutic effect of stent grafts in two internal carotid artery pseudoaneurysms was achieved. No recurrence was found during a post-operative follow-up of 15 months to 6 years. Conclusion Iatrogenic pseudoaneurysms of carotid and vertebral artery deserve a priority attention. Cerebrovascular angiography should be performed if needed. The neurosurgical intervention for iatrogenic pseudoaneurysms may yield an excellent outcome.

Objective Report the experience of management of graft occlusion in patients with lower extremity bypasses and discuss the appropriate treatment strategy. Methods From Oct. 2004 to Oct.2009, 104 cases of graft occlusion were treated in 53 patients with lower extremity arterial bypasses,including medical therapy for 10 cases and redo operations for 94 cases: graft thrombectomy alone for 26 cases, redo bypass or extension bypass with prosthetic or autologous vein grafts for 23 cases, graft thrombectomy plus balloon angioplasty for 18 cases,major amputation for 14 cases, graft thrombectomy plus femoral or popliteal artery endarterectomy for 10 cases, removal of occluded graft with infection for 2 case, and autologous stem cell transplantation for 1 case. Results 77 reconstructive procedures were applied and graft failures recurred in 49 cases (63.6%). One patient died of acute renal failure during peri-operaitve period and 9 patients died during follow-up; 6 patients were lost to follow-up. The remaining 37 patients were followed: major amputation for 12 patients, patent grafts after reconstruction in 18 patients, and medical therapy after graft occlusion for 7 patients with limb salvage. Kaplan-Meier survival analysis revealed 3-year survival of 77.4%, limb salvage of 64. 7%, and graft patency of 45. 7% . Effect of different procedures on cumulative patency was of no statistical significance. Conclusions Graft occlusions after lower extremity bypasses may result in high rate of reocclusion and amputation. Optimal management should be based on a thorough analysis of individual condition.

Objective The effects of stretch sensitive positive ion channel, the internal flow of Ca2+ and myristoylated alanine-rich C kinase substrate (MARCKS) on the high externalization of MUC5AC in airway epithelial cells in mechanical stretching. Methods Mini-type Multi-fuctional Bio-impact Machin was used to construct the model of mechanical stretching. The airway epithelial cells were divide into control group, stretch, stretch and gadolinium , stretch and low molecular weight heparin, stretch and nifedipine ,stretch and the locked nucleic acids of MARCKS effective domain ( ED), stretch and the control locked nucleic acids of MARCKS ED groups. The expression of MUC5AC and SNAP23 protein in cells were determined by immunohistochemistry method, contents of MUC5AC and SNAP23 protein were measured by Image Pro Plus 5.0. MUC5AC protein in supernatant was determined by ELISA methods. SNAP23 mRNA was determined by RT-PCR methods. Results Mechanical stretching could increase the expression of SNAP23 and MUC5AC in cells and MUC5AC in supernatant( P ＜ 0. 05). Gadolinium , nifedipine and LNA of MARCKS ED could reduce the increase the expression of SNAP23 and MUC5AC in cells and MUCSAC in supernatant(all P ＜0. 05). ConclusioN Mechanical stretching could increase the expression of MUC5AC in airway epithelial cells. This maybe is concerned with stretch sensitive positive ion channel, the internal flow of Ca2+ and MARCKS.

Objective To conduct an in vivo optical imaging analysis of the biodistribution of antibody Rituximab in lymphoma tumor-bearing nude mice. Methods Laser scanning confocal microscope and flow cytometry were employed to determine the affinity of FITC-labeled Rituximab (FITC-Rituximab)with human lymphoma Raji cells. And the in vivo optical imaging system was used to analyze the biodistribution of FITC-Rituximab in lymphoma-transplanted xenograft nude mice. Results The results of flow cytometry and laser scanning confocal microscope demonstrated that FITC-Rituximab had remarkable affinity with lymphoma Raji cells and was mainly bound at cell membrane. The results of in vivo imaging analysis suggested that FITC-Rituximab could specifically accumulated at peritumor tissue less than 1 h, then penetrated into the interior of tumor and concentrated in 3-4 h. And the specific concentration of FITCRituximab could still been observed more than 8-10 h whereas there was no apparent fluorescence at other tissues. Furthermore, the results observed from a two-flank tumor xenograft model showed that FITCRituximab possessed specific binding affinity for CD20-overexpressed lymphoma. Conclusion The in vivo optical imaging system can accurately monitor the distribution of FITC-Rituximab in tumor-bearing nude mice. And this technique has a reference value and significance for a real-time analysis of tumor-targeting capability of antibody drugs.

Objective To investigate the selective innervation of sacral anterior rootlets to micturition and erection function in SD rats. Methods Forty male SD rats of clean grade, aged 6 weeks old, were selected. Ten rats received a retrograde nerve tract tracing study. Thirty rats were chosen for an electro-physiological study. The L6, S1 spinal cord segment anterior rootlets of anesthetic rats were electrostimulated respectively. The intravesical pressure, urethral perfusion pressure and intracarvernerous pressure were recorded simultaneously and innervation effectiveness was analyzed. Results CB-HRP labeled neurons were observed mainly in L6 and S1 spinal cords. When some anterior rootlets of L6 and S1were electrostimulated, the intravesical pressure rose gradually, but the urethral perfusion pressure and the intracavernous pressure curve changed slightly; when other rootlets of the same anterior root were stimulated,the urethral perfusion pressure could reach the peak; while others were stimulated, the intracavernours pressure rose quickly, but there were no great changes in intravesical pressure and urethral perfusion pressure. Some other rootlets might lead to the simultaneous changes of 2 or 3 above-mentioned pressures.Conclusion The innervations of L6 and S1 anterior rootlets to rats' bladder detrusor, external urethral sphincter and penile cavernous body are significantly distinct. Different rootlets may be distinguished by microanatomy and electrostimulation.

Any space-occupying lesions in the cranium, whether neoplastic or non-neoplastic, mostly need to make pathological diagnosis. A definite pathological diagnosis is the basis for neurosurgeons to decide how to treat and whether to operate, and it is also the prerequisite for determining radiotherapy and chemotherapy. With the help of brain stereotactic instrument, the diseased tissues in the brain, especially the small lesions in the brain, can be accurately obtained under the condition of little surgical invasion, so as to clarify their pathological nature and carry out correct treatment.

From April 24 to 25, 2010 in Tianjin, more than 100 experts and scholars from all over the country engaged in clinical work of rheumatic diseases participated in the fifth anniversary of the listing of Yisaipu and the fifth Yisaipu Summit Forum sponsored by Shanghai CITIC Guojian Pharmaceutical Co., Ltd. This forum had 10 speech topics, covering the basic and clinical research hotspots of rheumatoid arthritis (RA) and ankylosing spondylitis (AS), summarized the experience of Yisaipu in treating juvenile idiopathic arthritis (JIA) and recurrent polychondritis, and introduced the safety of vaccination and tumor risk of patients treated with biological agents.