Volume 92  ·   Issue 47  ·  2012

If endovascular repair technology (EVAR) has realized the transformation of aortic surgery from huge invasive to minimally invasive, endovascular reconstruction of branch vessels can be called the second revolution in aortic surgery. Endovascular reconstruction of branch vessels makes the application of endovascular grafts break through the anatomical limitation of important branch vessels, and completely EVAR repair of complex aortic lesions from drawing to reality. The difficulty of treatment is mainly reflected in the technical treatment of three special aortic branches: internal iliac artery (IIA), visceral artery (VA) and brachiocephalic artery (CBA). In addition, the differences in target organs of branch vessels lead to different methods, instruments, risks and benefits of endovascular reconstruction of these branch arteries. We will briefly describe the effective methods and medical evidence for evaluating endovascular reconstruction of branch vessels in different sites.

Stanford type B aortic dissection (AoD) is the most dangerous and difficult emergency in the surgical field from the descending arc to the aortoiliac artery. Its annual incidence rate in Europe and America is (3~4) /100,000 people, and the mortality rate before admission is as high as 20%, and the mortality rate in hospital is as high as 30% [1]. There are two classification methods for this disease. Stanford classification divides it into type A (dissection involving the ascending aorta and the arc) and type B (involving the descending aorta and more). DeBakey classification is divided into DeBakey type Ⅰ (involving both ascending and descending aortas), type Ⅱ (involving only the ascending aorta) and type Ⅲ (involving only the descending aorta). After AoD occurs, acute dissection occurs within 14 days, and chronic dissection occurs after 14 days. Dissection can be divided into two types: complex and non-complex. Complex type B aortic dissection is defined as dissection combined with visceral or limb ischemia (malperfusion of branch vessels), rupture or imminent rupture, intractable pain and/or uncontrollable hypertension, etc. The latter two should be undergone after receiving adequate hibernation

The recurrence of stroke is closely related to transient ischemic attack and minor stroke. Many studies have shown that the probability of recurrence of stroke after transient ischemic attack and minor stroke is high, and many of the patients with transient ischemic attack and minor stroke with recurrence of stroke are cryptogenic stroke patients in the TOAST (trial of Orgl0172 in acute Stroke treatment) classification. in order to prevent and reduce the probability of recurrence of stroke in this population, Simerpreet Bal of Canada and others conducted related studies. They found that the incidence of recurrence of stroke in imaging is higher in patients with iliac transient ischemic attack and minor stroke. The results of this study were published in the online edition of Stroke, published online ahead of print October 2, 2012.

Objective To evaluate a novel method of combining use of bare stent and coils in the treatment of aortic dissection with distal tear at celiac trunk.Methods From April 2007 to August 2010,two cases of Stanford type B dissections underwent initially endovascular stent-grafting to seal proximal tears while distal tears at celiac trunks failed to seal spontaneously.Bare stents were then implanted into celiac trunks crossing tears.And an appropriate amount of coils were pushed into false lumen via a catheter passing through the holes of stents for maintaining the patency of celiac trunk and sealing tears.Results Both procedures succeeded.False lumen was indistinct on angiography while celiac trunks were patent.No complication occurred.After the follow-up periods of 5 and 2 years respectively,false lumen disappeared and celiac arteries became patent.Conclusion The novel method of combining use of bare stent and coils is technically simple.It required a simple puncture.Major traumas of open and hybrid operations are avoided.It is also indicated for cases of tears at renal or superior mesenteric arteries.As a supplemental method for conventional TEVAR,radical cure may be achieved for some complicated Stanford B dissections.

Objective To explore the option and efficacy of endovascular aneurysm repair (EVAR)for abdominal aortic aneurysm (AAA) with hostile aortic proximal landing anatomy.Methods The clinical data of 51 AAA patients with hostile aortic proximal landing anatomy treated by EVAR from January 2010 to June 2012 at our hospital was retrospectively analyzed.There were 44 males and 7 females with a mean age of 73 years (range:42-94).The anatomic measurements included a diameter of aneurysm body 32-100 mm,a length of proximal neck 0-50 mm,a width of proximal neck 15-40 mm and infrarenal angulation 15-80 degrees.In addition,there were calcification (n =10) and thrombus lining with aortic neck (n =15) and irregular shape of aortic neck (n =5) respectively.The stent-grafts were deployed by 4 femoral arteries.Results Many types of aortic stent were used,such as Endurant (n =9),Talent (n =5),Zenith (n =31),Hercules (n =5),Palmaz/CUFF (n =6) and multilayer bare-stent (n =2).And 11 patients underwent fenestrated EVAR and 31 with chimney EVAR involving renal artery (39 branches),superior mesenteric artery (3 branches) and celiac trunk (3 branches).The primary technical success rate was 100％.The perioperative endoleak rate was 17.6％.During the mean follow-up period of 13 months (2-28),the primary patency of stent was 96.1％ and the thrombus rate of aneurysm 82.4％.Two cases of new endoleak and 3 cases of residual endoleak underwent secondary intervention.In addition,long-term follow-up was required for 3 patients with stent-graft migration (＜ 10 mm).There was no case of death,infection,occlusions,ischemia of lower limbs,aneurysm expansion or rupture.Conclusion A variety of EVAR options are both safe and efficacious in the treatment of AAA with hostile proximal landing zone.

Objective To evaluate the outcomes of endovascular repair (EVAR) versus open repair (OR) in the patients with abdominal aortic aneurysm (AAA) and compare their perioperative rates of morbidity and mortality.Methods The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed.Endovascular (n =174) and open (n =197) repairs were performed.The relevant parameters included preoperative status,intraoperative blood loss,procedure time,intensive care unit (ICU) stay length,ventilatory support time,postoperative fasting time and duration of postoperative hospital stay and anesthesia methods.The perioperative rates of morbidity and mortality were presented.Results The patients of EVAR group were elder than those of OR group [(72 ±8) vs (60 ± 14)years old,P =0.000].The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OR group (31.0％ vs 21.8％,P =0.045).As compared with OR group,the EVAR group had less blood loss [(125 ±43) vs (858 ±602) ml,P =0.000],a lower rate of blood transfusion (0 vs 71.1％,P =0.000),shorter ICU stay length [(15 ± 5) vs (31 ± 11) h,P =0.000],shorter postoperative fasting time [(7 ±4) vs (90 ± 32) h,P =0.000],shorter procedure time [(146 ±39) vs (210 ± 24) min,P =0.000] and shorter ventilatory support time [(90 ± 23) vs (220.0 ± 132.0)min,P =0.000].In EVAR group,general (88,50.6％),epidural (52,30.0％) and local (34,19.4％)anesthesia were used.General anesthesia was used for all OR group patients.The duration of postoperative hospital stay was similar in two groups (9.1 ± 2.7) d vs (9.2 ± 2.6) d (P =0.798).The perioperative complication rate was lower in EVAR group (12.6％ vs 27.0％,P =0.001).And the 30-day mortality rate was 1.15％ in EVAR group and 2.0％ in OR group.Conclusion Endovascular repair is lessinvasive in AAA patients and offers significant advantages over open surgery.Especially it is indicated for those patients non-suitable for open surgery.And a long-term survival rate is expected.

Objective To evaluate the efficacy of endovascular aortic repair plus chimney technique in the treatment of Stanford type B aortic dissection involving aortic arch.Methods From June 2009 to March 2012,32 patients of aortic arch dissection with primary entry tear next to the orifices of supra-aortic arteries were treated with chimney technique.Chimney technique was used to reconstruct left subclavian artery (n =2) and left common carotid artery (n =28).Double chimney technique was use to reconstruct innominate artery and left common carotid artery simultaneously in 2 patients.Results Four patients received emergency operation.All patients survived and were followed up for 14.3 ± 7.4 months.No type Ⅰ endoleak occurred.Among 4 patients with Type Ⅱ endoleak,3 received PDA occluding implantation in left subclavian artery and 1 patient in puerperium with Marian syndrome and pregnancy-induced hypertension syndrome recovered by conservative treatment.No severe neurological complications and left subclavian artery ischemia occurred.The locations of aortic and chimney stent-grafts were stable without any migration.All stent-grafts remained patent.Conclusion Endovascular aortic repair plus chimney technique is a safe and effective treatment for Stanford type B aortic dissection involving aortic arch.

Objective To explore the management strategies of pyogenic vascular prosthetic graft infection.Methods The clinical data of 5 cases of prosthetic vascular graft infection in lower extremity between 2003 and 2010 were retrospectively analyzed.Results All of them were treated by antibiotics,debridement and drainage.One patient died from acute myocardial infarction and septic shock.Two patients were cured by extra-anatomic arterial bypass and removal of infected graft after a basic control of infections.And another two patients had the diseased limb amputated after the removal of infected vascular graft without blood reconstruction.Conclusion Pyogenic infection of vascular graft is hard to treat with conservative measures.Revascularization prior to removal of infected graft is recommended for a better outcome.

Objective To explore the operative techniques and efficacy of transsylvian-insular approach endoscopic surgery for hypertensive basal ganglia hemorrhage.Methods A retrospective analysis was conducted in 54 patients with hypertensive basal ganglia hemorrhage from December 2009 to December 2011.All of them underwent neuroendoscopic surgery via a transsylvian-insular approach.The hematoma volume was 30-40 ml (n =8),40-50 ml (n =42) and ＞ 50 ml (n =4).And the Glasgow Coma Scale (GCS) was 8-12 (n =48) and 13-15 (n =6).Results The clearance rate of hematoma was ＞90％ (n =44) and 80％-90％ (n =10).None suffered re-hemorrhage or death.Conclusion As a miniinvasive and efficacious approach for hypertensive basal ganglia hemorrhage,transsylvian-insular approach endoscopic surgery has a high clearance rate of hematoma is high and causes minimal damage to normal brain tissue.It is worth of clinical promotion.

Objective Whether small vessel infarction (SVI) correlates with large arterial lesion is under debate.The aim of the present study was to analyze the relationship between the single SVI in carotid territory by diffusion weight imaging (DWI) and arterial lesion by contrast enhanced magnetic resonance angiography (CEMRA).Methods Sixty patients with acute cerebral infarction underwent DWI within 7 days and CEMRA within 2 weeks after onset They were divided into 2 groups of patients with and without single SVI.The clinical and magnetic resonance image features were compared between two groups.Results Lesions of ipsilateral extracranial carotid artery were detected in 10 patients of SVI groups (36％) versus 8 patients (25％) of non-SVI group (P =0.54).Incidence of intracranial vascular lesion in single SVI group (32％) was slightly lower than that of non-SVI group (47％) (P =0.52).And 46 patients (77％) were assessed on plaque of carotid artery.Incidence of ipsilateral carotid artery plaque (44％) was higher in single SVI group than that of non-SVI group (35％) (P =0.76).And the incidence of vulnerable plaque in single SVI group (26％) was similar to that of non-SVI group (22％) (P =0.73).Conclusion SVI has not a single underlying mechanism of stroke.However,further studies with a large number of patients are waranteed.

Objective To explore the value of power Doppler ultrasound (PDU) in the evaluation of acute kidney injury(AKI).Methods Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed.All cases were divided into 3 groups by PDU score.AKI stage and duration were compared.And the co-variables of death and (continuous renal replacement therapy) CRRT days (＞3) were also analyzed by Logistic regression analysis.Results A total of 40 AKI case were recruited.The 3-score group(n =13)has lower mortality in intensive care unit and at 28 days than the 2-score group (n =15) and the 1-score group (n =12).The number of stage-3 AKI in the 3-score group was less than that in the 2-score and 1-score groups (n =1,4,9 correspondingly,x2 =16.103,degree of freedom =4,P =0.003).The number of persistent AKI in the 3-score group was less than that in the 2-score and 1-score groups (n =3,9,10 correspondingly,P ＜0.05).Age,APACHE Ⅱ score and PDU score(＜3)were closely correlated with death while age,APACHE Ⅱ score,level of serum creatinine and PDU score(＜3)with CRRT days(＞3) (P ＜0.05).Conclusion PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.

Objective To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery.Methods From December 2009 to June 2010,119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia.There were 75 males and 44 females with a mean age of 44.8 years (range:15-55).The mean disease course was 9 months (range:3-72).The major symptoms were back pain and/or unilateral sciatica.The mean follow-up period was 26 months.All underwent lumbar radiography,computed tomography (CT) and magnetic resonance imaging (MRI) revealing 112 single level and 7 two-level disc herniations.There were 82 lateral and 37 para-medial disc herniations.Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs.There were no obvious lumbar stenosis,spondylolithesis,fracture,infection or tumor cases.The preoperative and postoperative visual analogue scale(VAS)were used to evaluate the sciatica and/or back pain.The outcomes were evaluated by Oswestry disability index(ODI) and the Macnab score.Precise orientation and operation was performed under the guidance of pre-operative imaging,intra-operative fluoroscopy or CT and endoscopic exploration.Results Among them,117 cases had the surgery performed successfully.The mean operative duration was 85 min (range:35-85) and the mean blood loss 13 ml (range:1-50).One patient had 15 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months.Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter.Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically.No one had a conversion into open surgery.They were followed up for a mean period of 26.1 months (range:25-27).Five patients lost follow-up.VAS improved statistically significantly from preoperative 6.8 to postoperative 1.8 (P ＜ 0.05).ODI decreased from preoperative 70.06 to 19.09 at the last follow-up.The Macnab results were excellent (n =82,68.9％),good (n =20,16.7％),fair (n =8,6.7％) and bad (n =9,7.7％) (including all patients lost to follow up).And the excellent-to-good rate was 85.6％.Conclusion With fewer complications and a low recurrence rate,percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.

Objective To evaluate the efficacy and safety of 1-year adjuvant trastuzumab (herceptin) versus 1-year non-trastuzumab observation in Chinese patients with HER2-positive early breast cancer during a median follow-up of 1 year.Methods The HERA trial was an international,multicenter,randomized,open-label,phase Ⅲ trial comparing treatment with trastuzumab for 1 and 2 years with observation after standard adjuvant chemotherapy,radiotherapy or both in patients with HER2-positive nodepositive or high-risk node-negative early breast cancer.The primary endpoint was disease-free survival.Secondary end points included recurrence-free survival,distant disease-free survival,overall survival and cardiac safety.The first planned interim analysis comparing the efficacy and safety of treatment with trastuzumab for 1 year versus observation were completed in April 2005.Only the outcomes of recruited Chinese patients were reported.Results A total of 122 Chinese patients from 8 participating centers were included for planned interim analysis.And they were divided into trastuzumab (n =68) and observation (n=54) groups.Three and eight disease-free survival events were observed in the trastuzumab and observation groups respectively.Two-year disease-free survival rates were 92.9％ and 81.4％ respectively (P =0.0489); 2-year recurrence-free survival and distant disease-free survivals were 98.1％ vs 81.4％ (P =0.0064) and 98.1％ vs 83.3％ (P =0.0117) respectively.Trastuzumab was generally well-tolerated with a decent safety profile.Severe cardiotoxicity was not observed.Conclusion One-year treatment with adjuvant trastuzumab improves disease-free survival,recurrence-free survival and distant disease-free survival in Chinese patients with HER2-positive early breast cancer.

Objective To observe the expression changes of Sirt1 gene and examine the role and significance of degenerative process in human cervical endplate chondrocytes through a degeneration model of human cervical vertebral endplate chondrocyte.Methods Cartilage endplates of 30 patients were divided into control group (n =16) with cervical vertebral fracture or dislocation and cervical spondylosis group (n =14) with cervical spondylotic myelopathy.Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro for 10 days.The differences of endplate chondrocytes from normal and degenerative cartilage endplates were observed by inverted phase-contrast microscope,hematoxylin and eosin staining and toluidine blue staining.Real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to detect the mRNA expressions of Sirt1,collagen Ⅱ and aggrecan.Results Compared with the normal group,the cellular morphology of degenerative group showed spindle-shaped changes.The mRNA expression of Sirt1 (P =0.034) significantly decreased.Aggrecan (P =0.0063) and collagen Ⅱ (P =0.0072)decreased also markedly.Conclusion Sirt1 gene expression is significantly down-regulated in degenerative human cervical endplate chondrocytes.Regulating the expression of Sirt1 gene may block or delay the occurrence of human cervical endplate cartilage degeneration.

Objective To evaluate the incidence,types and clinical significance of coronary artery fistula (CAF) on CT coronary angiography (CTCA).Methods A total of 48 533 consecutive patients undergoing CTCA at 4 Chinese hospitals were retrospectively analyzed.The incidence,types and clinical significance of CAF were retrospectively summarized.Results One hundred and two patients had CAF with the incidence of 0.21％ (102/48 533).Among them,coronary to pulmonary artery fistulas were seen in 92 patients (90.2％,92/102),coronary to right atrium fistula in 4 (3.9％,4/102),coronary to right ventricular fistula in 2 (2.0％,2/102),coronary to right ventricular fistula in 2 (2.0％,2/102),coronary to left atrium fistula in 1 (1.0％,1/102) and coronary to small cardiac vein in 1 (1.0％,1/102).Among 92 coronary to pulmonary artery fistulas,fistulas originated from both coronary arteries in 46 patients (50.0％,46/92),from left coronary artery in 28 (30.4％,28/92) and right coronary artery in 11 (12.0％,11/92) and the remaining 7 (7.6％,7/92) coronary to pulmonary artery fistulas were associated with extracardiac communications.Conclusion The incidence of CAF is 0.21％ with a predominance of coronary to pulmonary artery fistulas (90.2％).The most common type of CAF is coronary to pulmonary artery fistulas from both coronary arteries (50.0％).Dual source CTCA can clearly visualize types and abnormal vessels so that it plays an important role in the diagnosis and preoperative evaluation of CAF.

Objective Accumulating evidence demonstrates that subarachnoid hemorrhage (SAH)-induced microthrombosis plays important roles in the pathogenesis of delayed cerebral ischemia.The purpose of the present study was to determine the impact of simvastatin on microthrombi formation and cerebral vasospasm after SAH and explore its mechanism.Methods A total of 24 adult male SD rats were divided into 4 groups:(1) control group (n =6) ; (2) SAH group (n =6) ; (3) SAH + vehicle group (n =6) and (4) SAH + simvastatin group (n =6).SAH was induced by injecting 0.3 ml of fresh arterial,nonheparinized blood into prechiasmatic cistern in 20 sec with a syringe pump.In the SAH + simvastatin group,simvastatin was administered ip at a dose of 20 mg· kg-1 · d-1 after SAH.Brain samples were excised after perfusion fixation at 7 days post-SAH.Microclots were evaluated by H&E staining.Microthrombi formation was measured by fibrinogen immunostaining.Results The number of microthrombi was 1 ± 1,25 ± 5,24 ±4 and 5 ± 2 in control,SAH,vehicle and simvastatin groups respectively.The number of microthrombi significantly increased in cerebral cortex at 7 days post-SAH (P ＜ 0.01).The treatment of simvastatin downregulated the formation of microclots in the SAH model and the number of microthrombi decreased significantly in the SAH + simvastatin group as compared with the SAH or SAH + vehicle groups (P ＜ 0.01).Conclusion The administration of simvastatin alleviates microthrombosis in late phase of SAH in this prechiasmatic blood injection model.

Objective To explore the changes of extracellular glutamate (Glu) and γ-aminobutyric acid (GABA) in hippocampus during the high-frequency stimulation of anterior nucleus thalamus (ANT) in epileptic rats.Methods A total of 30 rats were divided equally into 2 groups:epilepsy model and normal control (n =15 each).Concentric bipolar electrodes were stereotaxically implanted in bilateral ANT.A highfrequency stimulation of 130 Hz was applied in the epilepsy group.Microdialysis probes were unilaterally lowered into hippocampus.The concentrations of Glu and GABA in dialysate samples were determined by high-performance liquid chromatography (HPLC).Results Electrical stimulation of ANT induced an increase of GABA and a decrease of Glu in hippocampus.Conclusion An increase of GABA and a decrease of Glu during the electrical stimulation of ANT play an important role in the therapy of epilepsy.

Objective To explore the relationship between heat shock protein 70 (HSP70)expression and radiotherapeutic sensitivity.Methods Retrospective analysis was conducted for HSP70 expression in surgical specimens of 70 patients with esophageal cancer and their radiotherapy effect; the siRNA plasmids were prepared to inhibit HSP70 expression.After culturing,the plasmids were transfected into EC9706 cells.After γ-ray irradiation,the cell numbers were compared with the control group.And the contents of HSP70 protein were measured by Western blot in transfected cells.Results In HSP positive group,patients with chemotherapy or chemoradiotherapy had a lower 2-year recurrence rate than the radiotherapy group(35％ vs 55％).In HSP-negative group,there was no significant difference.After γ-ray irradiation,the number of RNA interference cell lines was significantly less than that of the RNA expression cell lines.Western blot showed that,after γ-ray irradiation,HSP70 expression increased,peaked at 16 hours and began to decline at 20 hours.Conclusion Esophageal squamous cell carcinoma is not sensitive to radiotherapy.The interference of HSP70 protein synthesis may become a new method of improving the efficacy of radiotherapy.

The patient was a 52-year-old male who was admitted to Peking Union Medical College Hospital for 2 years with progressive visual loss in both eyes and headache. Physical examination: Shen Qing Li, physical examination cooperation. Cardiopulmonary and abdominal (-). Specialist physical examination: visual acuity and visual field examination showed right eye superior temporal hemianopia, nasal threshold reduction small dark spot, left eye temporal hemianopia, nasal and central dark spot, left eye visual acuity 0.8, right eye visual acuity 1.0. Past medical history: hypertension for 6 years, well controlled by taking antihypertensive drugs such as captopril and nimodipine. Hyperlipidemia for 5 years, controlled by taking Xuezhikang in white. Five years ago, he was diagnosed with old myocardial infarction and multiple lacunar infarction, and took Xiaoxintong and Danshen tablets for a long time. Endocrine examination: prolactin 25.7 μ g/L, testosterone 147.0 μ g/L, total blood cortisol and thyroid function were normal.

The "Ninth National Radiation Oncology Therapy Conference of Chinese Medical Association" organized by the Radiation Oncology Therapy Branch of Chinese Medical Association was held in Jiuhua Villa, Changping District, Beijing on September 14-16, 2012. This conference is the first academic annual conference held by Professor Li Yexiong, chairman of the Radiation Oncology Therapy Branch of the 7th Chinese Medical Association and director of the Radiotherapy Department of Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences, during his tenure. The three-day academic conference, except for the plenary conference on the first day, all adopted the form of sub-venue speeches, update classes and satellite meetings, among which the plenary conference and sub-venue speeches occupied the main time, that is, 8:00~12:00 and 14:00~18:00, while the update class was arranged from 7:00~7:50, and the satellite conference was held from 12:00~14:00. This arrangement of the conference process not only saves time compactly, but also has the freedom to choose the weight.

From November 9 to 11, 2012, the 11th National Symposium on Advances in Head and Neck Imaging and the 14th Study Class on New Advances in Head and Neck Imaging were held as scheduled in the Greenland Platinum Hotel, Pudong, Shanghai. Qiu Weiliu, Academician of China Academy of Engineering, Academician of Oral and Maxillofacial Surgery, Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Dai Kerong, Academician of China Academy of Engineering, Department of Orthopedics, Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Gao Hong, Director of the Editorial Board of Chinese Journal of Radiology, Wang Zhenchang, Secretary-General of China Radiology Branch, Head and Neck Group, Director of Radiology, Beijing Tongren Hospital, Chen Hongzhuan, Vice Dean of Shanghai Jiaotong University School of Medicine, More than 500 people attended the conference, including Dean Zhang Volunteer of the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine and leaders and experts from Shanghai and all over the country.

pharmacogenomics developed in 1990s reveals the genetic characteristics of these differences from the genetic level, and provides objective basis for guiding individualized medicine. This paper mainly discusses the main contents of pharmacogenomics in recent years, the current research progress and the discovery in individualized treatment of dementia, and provides reference for deepening the research in this field.

The proband (Figure 1Ⅲ5), a 49-year-old female, was hospitalized in 2007 due to progressive difficulty walking of both lower limbs for 4 years. At the age of 39, she gradually developed weakness of both lower limbs, difficulty ascending stairs, gradual thinning of both lower limbs, numbness of both feet, difficulty walking on the flat ground at the age of 43, easy to fall, and weak strength of both upper limbs. Physical examination: normal intelligence, cross-threshold gait, mild atrophy of the thenar muscles of both hands, obvious atrophy and thinning of the muscles below the junction of the middle and lower 1/3 of both thighs, showing the shape of "crane legs". No "arched foot" deformity was observed. The grip strength of both hands decreased, the muscle strength of both lower limbs was grade 3~4, the dorsal flexion and plantar flexion of both feet could not be observed. The muscle tone of the limbs decreased. Bilateral knee reflex and ankle reflex (-), bilateral pathological signs (-). The glove-like pain algesia of the limbs decreased, and the sense of position and vibration of both feet disappeared. The fasting blood glucose was between 5.0~5.4 mmol/L at the age of 41~43. In 2007, the fasting blood glucose was 7.6~14.1 mmol/L, and the glycosylated hemoglobin was 9.3%. He was diagnosed with type 2 diabetes.

Case 1, a 31-year-old female, was admitted to the hospital due to "recurrent excessive drowsiness and occasional limb twitching for 3 months". The patient had increased sleep without obvious trigger 3 months ago, could not be aroused, did not eat during this period, and continued sleeping for 20-36 hours each time to wake up spontaneously. The attack occurred about once a week, at night and during the day, and sometimes appeared convulsive attacks during sleep, manifested as eyes turning up, refusing to respond to calls, limbs twitching, lasting for 2-3 minutes to relieve spontaneously, no tongue bite and fecal incontinence. Sometimes she spoke nonsense intermittently, cried loudly, vomited, and sweated profusely. After taking carbamazepine, the symptoms did not improve. Since the onset of the disease, the patient was in good spirits, with poor appetite, weight loss of 2 kg, and near-memory loss. He was in good health. Physical examination at admission: blood pressure 90/60 mm Hg (1 mm Hg =0.133 kPa), clear mind and sharp speech, near-memory loss. No abnormalities were found in the physical examination of Yu neurology. No special in the physical examination of heart, lung and abdomen. Auxiliary examination: blood glucose 1.42 mmol/L, but no abnormalities were found.