Volume 97  ·  Issue 17  ·  2017

Craniopharyngioma, which should be curable, is a benign tumor of the nervous system that frustrates neurosurgeons^[1]。 Craniopharyngioma accounts for 6%-9% of intracranial tumors and 54% of sellar tumors in children, with an annual incidence rate of 1.3/1 million in the population. Craniopharyngioma is not only a rare disease, but also a common intracranial tumor in children. It is derived from the residual tissue of the embryo, and the histology is benign. Surgical treatment is extremely challenging due to the deep location of the tumor^[2]Radiotherapy, stereotactic radiosurgery, internal irradiation therapy, chemotherapy and other methods for the treatment of malignant tumors have been used as conventional methods for the treatment of craniopharyngioma by hospitals in many countries and regions. Even so, the high recurrence rate, low quality of life and low long-term tumor-free survival rate of craniopharyngioma make craniopharyngioma the only benign tumor with a malignant outcome^[3]。

In 1932, Professor Cushing pointed out that craniopharyngioma is the most troubling intracranial tumor for neurosurgeons. To this day, performing satisfactory surgical treatment for patients with craniopharyngioma remains a great challenge for neurosurgeons. On the one hand, there is still debate about the best treatment strategy for craniopharyngioma. On the other hand, due to the uneven understanding of craniopharyngioma, the treatment options for craniopharyngioma are very different in different medical institutions. In addition, insufficient understanding of pituitary-hypothalamic dysfunction such as postoperative water-electrolyte disorder, endocrine dysfunction, obesity, cognitive dysfunction, etc. seriously affects the prognosis of craniopharyngioma patients. In order to improve the treatment level of craniopharyngioma, the Pediatric Neurosurgery Group of Neurosurgery Branch of Chinese Medical Association organized experts from neurosurgery, radiotherapy and endocrinology to write the Expert Consensus on the Treatment of Craniopharyngioma (hereinafter referred to as this consensus), hoping that through this consensus, Chinese doctors can deepen their understanding of the pathophysiological state of craniopharyngioma, improve the treatment level of craniopharyngioma, standardize the treatment, and then improve the prognosis of patients.

To explore the correlation between clinical symptoms of patients with obsessive-compulsive disorder (OCD) and the activation pattern of brain neurons at resting.

A total of 26 patients diagnosed with fist-episode OCD were selected and underwent functional magnetic resonance imaging (fMRI) scanning at resting state. The fMRI data were processed by statistical parametric mapping (SPM8), Data Processing Assistant for Resting-State fMRI Analysis Toolkit (DPARSFA), and Resting State fMRI Data Analysis Toolkit (REST) software. With age as concomitant variable, Pearson Correlation Analysis was adopted to study the correlation between clinical symptoms (obsessive thoughts and compulsive behavior) of patients and their regional homogeneity ( ReHo) values of whole brain.

The positive correlation between obsessive thoughts score of patients with OCD and ReHo value lied in insular_L, insular_R, cerebellum_L, cerebellum_R, calcarine_L, cuneus_L. The negative correlation between obsessive thoughts score of patients with OCD and ReHo value lied in thalamus_L, precuneus_L, caudate_L, cingulum_R, frontal_R. The positive correlation between compulsive behavior score of patients with OCD and ReHo value lied in temporal_L, frontal_inf_orb_l, frontal_inf_orb_R, frontal_mid_L, precentral_R. The negative correlation between compulsive behavior score of patients with OCD and ReHo value lied in cingulum-L, cingulum-R, caudate_L.

Different obsessive-compulsive symptoms has different image foundation, and the dysfunction of cingulate has a major impact on the incidence of both obsessive thoughts and compulsive behavior of OCD patients.

This study was to describe the clinical characteristics of Anti-leucine-rich glioma inactivated 1 protein(LGI1) antibody associated limbic encephalitis.

Clinical data including clinical features, laboratory and radiological findings, treatment and prognosis of the 9 patients were analyzed.

In all 9 cases, 6 cases experienced epileptic seizure, 5 cases had psychosis, 7 cases presented with memory impairment, 4 cases showed faciobrachial dystonic seizure, 2 had refractory hyponatremia. One case presented with typically acute Guillain-Barre syndrome (GBS). Anti-LGI1 antibody was detected in 6 cases in cerebrospinal fluid (CSF) samples and 9 in serum samples. Seven cases out of 9 had brain imaging abnormalities. All 9 cases found no evidence of tumors. Eight cases were given immune therapy. During a 1-16 months follow-up, 1 case had complete recovery, 5cases had various degree of sequelae , among whom 4 had memory disturbance and 1 case had changed personality. 2cases were lost to follow-up.

Limbic encephalitis is the most common manifestation of anti-LGI1 antibody associated encephalitis. Faciobrachial dystonic seizure (FBDS) is a specific symptom which favors an early diagnosis. Tumor is uncommon to see. The disease has a relatively favorable prognosis while impaired memory can be seen as a common sequelae.

To explore the MRI manifestation of encephalopathy of prematurity (EOP), so as to find an access to the early prevention, early diagnosis, effective treatment and prognosis.

A total of 2 718 premature infants were collected, MRI and clinical data were analyzed who were admitted to NICU of Children′s Hospital of Fudan University between January 1, 2009 and December 31, 2014. The manifestation and lesions distribution in MRI were analyzed.

All the 2 718 preterm infants underwent MRI. 58.8% (1 599/2 718) of which had normal MRI apperance, whereas 24.9% (678/2 718) showed manifestations of EOP.78.8% (534/678) EOP were non-cystic EOP. 21.2% (144/678) EOP were cystic EOP. Periventricular and cerebral lobe white matter were primary distributions of these lesions. Cystic lesions were primarily distributed in the body of periventricular whiter matter (49.3%). However, more non-cystic EOP were found in cerebral parietal lobe whiter matter (25.1%). Non-cystic EOP were also distributed in the body of periventricular whiter matter, frontal lobe and basal ganglia(20.8%, 20.2% and 18.9%, respectively ).

The morbidity rate of EOP in preterm infants was 24.9%. 21.2% (144/678) EOP were cystic EOP. 78.8% (534/678) EOP were non-cystic EOP. Cystic lesions were primarily distributed in the body of periventricular whiter matter. Non-cystic EOP were also distributed in the body of periventricular whiter matter, frontal lobe and basal ganglia.

To evaluate the characteristics of high resolution diffusion-weighted imaging(DWI) using readout segmentation of long variable echo trains (RESOLVE ) for nasopharyngeal carcinoma (NPC).

A total of 131 with newly diagnosed NPC patients from the 5th Affiliated Hospital of Sun Yat-sen University were included in this study from October 2013 to April 2016.DWI using RESOLVE technique was performed. The signal intensity (SI_lesion), and mean(ADC_mean), maximum(ADC_max), minimum (ADC_min)ADCs of NPC were calculated. The signal intensity (SI_normal)and ADC (ADC_normal)of normal nasopharyngeal tissue were calculated. These quantitative parameters of NPC and normal nasopharyngeal tissue were compared.Statistical difference of ADC_mean, ADC_max and ADC_min between the clinical tumor stages were assessed.

On the DWI, all NPCs were clearly shown as high signal intensity relative to the surrounding normal nasopharyngeal structure(F=70.019, P=0.000). The ADC_mean(F=20.442, P=0.000), ADC_max(F=35.374, P=0.000), ADC_min(F=61.534, P=0.000) in the carcinoma were significantly lower compared with that of normal nasopharyngeal structure. There was no statistically significant difference of ADC_mean, ADC_max and ADC_min (P>0.05)in different clinical stages of NPC.

NPC can be clearly detected by RESOLVE-DWI, but the ADC_mean, ADC_max and ADC_min can not be used for differentiating the clinical stage of NPC.

To explore the MRI features of the pure mucinous breast carcinoma(PMBC) and the correlation with cell density and the expression of immunohistochemistry.

MRI features of 35 pure mucinous carcinomas were retrospectively analyzed from January 2011 to May 2016 in Guangdong General Hospital. MR images were reviewed for shape, margin, the signal intensity, enhancement patterns of tumors and diffusion weighted imaging (DWI) features and apparent diffusion coefficient (ADC) value. All the patients were detected by immunohistochemical staining with expression of ER, PR, CerbB-2, Ki-67 and Her-2. Correlations between MRI features of PMBC and cell density and the expression of immunohistochemistry were analyzed.

A total of 16 oval masses(16/35, 45.7%) and 10 round masses(10/35, 28.6%)were found in 35 PMBC with clear boundary(26/35, 74.3%) and lobulated shape(31/35, 88.6%). Very high signal intensity on T₂-weighted images was found in 33 PMBC (33/35, 94.3%) and early enhancement rate was 115%±9% for PMBC. 28 PMBC demonstrated persistent enhancing pattern on time-signal intensity curve and 7 PMBC demonstrated plateau pattern.Mean ADC value was (1.91±0.06)×10^-3mm²/s for PMBC. There was significant difference with early enhancement rate and ADC value between PMBC with more or less quantities of cellular mucin (P<0.05). There was no significant difference with ER, PR, CerbB-2, Her-2 and Ki-67 expression between PMBC with more or less quantities of cellular mucin (allP>0.05).

PMBC has distinctive MRI features. The prognosis of PMBC is better from correlation between MRI features, cell density and the expression of immunohistochemistry.

To investigate the value of duodenal bulb ultrasonic anatomy locating method quickly confirm nasointestinal tube placed below pylorus in critically ill patients.

A total of 56 critically ill patients with nasointestinal tube posting surgery by blindly inserting method were collected from March 1 st, 2016 to August 1 st, 2016 in the Department of Critical Care Medicine of Zhejiang Provincial People′s Hospital.In these patients, the duodenal bulbs were rapidly detected and located by ultrasonic anatomy locating method and at the same time observed whether nasointestinal tube echogram were in them or not. If nasointestinal tube echogram was observed in duodenal bulbs that meant nasointestinal tube placed below pylorus successfully. If disturbed by ultrasound artifacts or other reasons, injected gas into the nasointestinal tube could help to confirm when hyperechoic strip emerged. Gastrointestinal decompression or gastrointestinal motion promoting drug could help to reduce the interference of abdominal cavity or bowel gas if necessary. The results were compared with the abdominal X examination to vertify the accuracy of this method, and at the same time recorded its total time-consuming and its related complications.

The duodenal bulbs were rapidly located by ultrasonic anatomy locating method in 53 cases(94.6%) time-consuming(42±23)s. Nasointestinal tubes observed in duodenal bulb were confirmed to be placed below pylorus successfully in 52 cases(92.9%)time-consuming(140±94)s.There were no obvious complications in all patients.

Duodenal bulb ultrasonic anatomy locating method is a safe, simple and convenient method with high accuracy that can quickly confirm whether nasointestinal tube placed below pylorus in critically ill patients or not.

To explore the radiological, pathological features and clinical characteristics of neuroendocrine prostate cancer patients(NEPC).

The clinical characteristics and pathology data of 13 neuroendocrine prostate cancer patients treated in the Affiliated Hospital of Tianjin Medical University from January 2004 to January 2015 were analyzed retrospectively.

Of all 13 patients, three cases were primally diagnosed small cell cancer, and 10 cases were translated to neuroendocrine type from adenocarcinoma after endocrine therapy. Frequent urination, urgency, nocturia, and dysuria were main symptoms. Serum prostate-specific antigen (PSA) was (14.5±3.2)μg/L; the volume of prostate was enlarged, mean volume, range 28-176(45±4)ml. The lesion was moderately low signal intensity in T₂WI, while slightly higher signal in DWI. Signal characteristic of dynamic enhanced MRI was "fast in fast out" . The expression of Synaptophysin, Chromogranin A , CD56 and Ki-67 in NEPC were highly expressed by immunohistochemistry analysis. Among them, five patients accepted intravenous chemotherapy, two cases received external radiation therapy, three cases received cryoablation and three cases received palliative therapy. Median survival time in all 13 patients was 10 months, while median survival time in patients treated by chemotherapy was 16 months .

NEPC is a highly aggressive subtype of prostate cancer characterized by rapid disease progression, lack of treatment and worse prognosis. Therefore, patients with NEPC may benefit from early diagnosis and comprehensive treatment with chemotherapy.

To investigate the clinical characteristics and surgical treatment of cervical spondylotic amyotrophy.

Thirteen patients(13 man) with proximal (10) and distal(3) cervical spondylotic amyotrophy between November 2014 and September 2016 were included in this study. The average age of the patients was 55 (range, 47-66) years. The sex, age, clinical course, type of amyotrophy, lesion segment and postdecompression improvement in muscle power were reviewed.

Of 13 cervical spondylotic amyotrophy patients, 9 were performed on with cervical disectomy, 2 were performed on with cervical posterior operation, 2 remainding patients received nonoperative treatment. Cervical spondylotic amyotrophy patients were followed up 6-22 (average 10.6) months, muscle power of 4 patients (all proximal-type)were improved completely (the average recovery time were 4.4 months), muscle power of 6 patients were improved uncompletely, 1 patients failed to improve, the 2 remainding patients received nonoperative treatment had no change.

Cervical spondylotic amyotrophy as a rare type of cervical spondylotic disorder, It should distinguish cervical spondylotic amyotrophy from amyotrophic lateral sclerosis, especially in the early stage of amyotrophic lateral sclerosis. A surgical treatment is recommended as the first line of proximal-type CSA, especially those with serious compression. It is important that clinicians should be aware that distal-type CSA had a poor results, resulting in a lower lower satisfaction, especially those with no, or insignificant, sensory disturbance.

To investigate the changes in the expression of NF-κB signaling pathway in human degenerative intervertebral discs.

From October 2014 to March 2016, 55 nucleus pulposus of surgical patients with degenerative human intervertebral disc were collected for study in Department of Orthopedic Surgey, Hospital of Zaozhuang Mining Corporation, and Department of Orthopedics, Shanghai General Hospital Affiliated Shanghai Jiaotong University, School of Medicine.The collected nucleus pulposus tissues were divided into two groups: experimental group(30) and control group(25). Cell culture observed normal and degenerative nucleus pulposus cells morphological changes; immunofluorescence observed NF-κB p65 changes in the nucleus of nucleus pulposus cells.Real-time PCR was observed changes in aggregated proteoglycans and matrix metalloproteinase gene mRNA.Finally, the use of blockers of nucleus pulposus cells were treated 24 hours, Western blot analysis the changing of p65, ADAMTS-4, MMP-13, aggregate proteoglycans and collagen Ⅱ protein expression.

Compared with the experimental group, the nucleus pulposus cells in the control group had larger cell volume, abundant cytoplasm and faster growth rate.Cell immunofluorescence show Nondegenerative nucleus pulposus cells p65 protein was mainly localized in the cytoplasm, degeneration of nucleus pulposus cells p65 protein was mainly concentrated in the nucleus.RT-PCR showed degenerative group of matrix metalloproteinases (MMP-1, MMP-3, MMP-13), aggrecanase(ADAMTS-4, ADAMTS-5) and IL-6 mRNA expression was significantly higher than Nondegenerative group; aggrecan and type Ⅱ collagen expression than those without degeneration group was significantly lower.Expression of nucleus pulposus degeneration in nuclear protein p65 with the degenerative level increased gradually increased.BAY11-7082 blocked the activity of NF-κB signaling pathway, which could significantly down-regulate the expression of ADAMTS-4 and MMP-13 protein and significantly up-regulate the expression of Agg and COLⅡ protein.With the increase of BAY11-7082 concentration, gradually strengthened.

The activation of the NF-κB signaling pathway in a degenerative intervertebral disc is gradually increased, regulating the over-expression of matrix-degrading enzymes.It plays an important role in the degradation of extra-cellular matrix.

To compare the positive rates of Chlamydia trachomatis (CT) in gynecological clinic and reproductive medicine clinic by detecting cervical samples from two clinics with three assays of different methodologies. To determine the performances of enzyme assay and immunochromatography (ICA) assay compared to the real-time PCR assay.

Seven hundred and eleven samples of gynecological clinic from May 2014 to May 2015 and 711 samples of reproductive medicine clinic from June 2014 to April 2015 were collected in Henan Province People′s Hospital. Three cervical swabs were collected from each participant. The three samples were eluted with saline water then mixed. The samples were detected with three methodologies respectively after dividing the mixture into three.

The positive rates of CT in gynecological clinic and reproductive medicine clinic were 9.98% (71/711) and 4.22% (30/711) by real-time PCR assay, 10.83% (77/711) and 5.06% (36/711) by enzyme assay, 4.78% (34/711) and 2.11% (15/711) by ICA assay. The sensitivity and specificity were 85.1% (86/101) and 98.0% (1 294/1 321) by enzyme assay. The sensitivity of ICA assay was 45.5% (46/101) and specificity was 99.8% (1 318/1 321) compared to the real-time PCR assay.

The positive rate of CT in gynecological clinic was markedly higher than that in reproductive medicine clinic (P<0.05). The ICA assay, while exhibiting a high specificity, had unacceptably low sensitivity compared to real-time PCR assay. The enzyme assay had higher sensitivity but slightly worse specificity.

To determine the effects of QO-58 on pain behavior associated with monosodium iodoacetate (MIA)-induced OA.

The OA model was established with an intra-articular injection of 3 mg/50 MIA through the right patellar ligament. Then the model rats were treated with 50 mg/kg QO-58 by intraperitoneal injection, and pain-related behaviors were assessed by single administration and multiple administrations of QO-58.

Single adminstration of QO-58 increased the mechanical threshold and prolonged the withdrawal latency of OA pain with the antinociceptive effect occurring at 6 h and 10 h. Compound QO-58 was administered intraperitoneally once a day from day 10 to 14. QO-58 significantly increased the mechanical threshold and prolonged the withdrawal latency of OA rats at 12 and 14 days.

QO-58 showed antinociceptive effects for OA pain in the MIA model after pain development. QO-58 may be an alternative therapeutic treatment for OA.

To describe the secular trends of institutional delivery (ID) rate in China from 1996 to 2015, and to assess the impacts of national health policies on the ID rate.

Data on the number of live births and IDs for districts/counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China. Information concerning the relevant policies was from official governmental websites, including the programme to reduce maternal mortality and eliminate neonatal tetanus (2000 to 2008), and ID subsidy programme in rural China (2009 to present). According to the programme to reduce maternal mortality and eliminate neonatal tetanus, the calendar years were categorized into three periods: pre-programme period (1996 to 1999), programme implementation period (2000 to 2008) and post-programme period (2009 to 2015).

A total of 244 398 010 live births were included in the analysis, in which 211 605 727 were delivered in institutions. During the 20 years, the ID rate steadily increased from 58.7% (6 309 255/10 739 816) in 1996 to 99.7% (13 583 658/13 626 948) in 2015, with a compound annual growth rate of 2.8%. Analyses stratified by economic regions or urban-rural areas showed notably consistent increases in ID rates, and the regional and urban-rural differences became nearly disappeared by 2015. The largest regional difference between East (71.6%, 2 540 896/3 547 423) and West (44.6%, 1 675 305/3 752 873) was 27% in 1996 and <1% in 2015 (East 99.9%[5 177 865/5 180 636]and West 99.0%[3 925 766/3 964 622]). The urban-rural difference was 22.7% in 1996 (urban 73.5%[2 756 531/3 748 703], rural 50.8%[3 552 724/6 991 113]) and 0.4% in 2015(urban 99.9%[6 257 853/6 262 763], rural 99.5%[7 325 805/7 364 185]). During the programme implementation period and the post-programme period, the ID rates in rural area increased faster than those in urban area, and the corresponding compound annual growth rates in rural area were 2.4 and 2.8 times of those in urban area; the ID rates in Middle and West regions increased faster than those in East region, and the corresponding compound annual growth rates in West region were 3.6 and 6.3 times of those in East region. By 2015, the ID rates in all provinces other than Tibet (90.5%[48 445/53 505]) and Qinghai (97.2%[60 836/62 600]) reached or were close to 100%. However, there were still 112 districts/counties with ID rates <96%, of which 39 with ID rates <80%; the 39 districts/counties were all located in four western provinces (Tibet 19, Sichuan 15, Qinghai 3, and Xinjiang 2).

During the past 20 years, the ID rate in China has steadily increased and achieved the goal of the year 2020 ahead of schedule; the regional and urban-rural inequality in ID has nearly disappeared. Given universal two-child policy, it is of significance to strengthen existing achievements, focus on complicated pregnancies and comprehensively improve the capability and quality of ID services; meanwhile, it is also of significance to develop particular policies and explore the medical-aid model for the minority-inhabited western regions with lower ID rates.

corticobasal syndrome (CBS) is a slowly progressing neurodegenerative disease, clinically characterized by extrapyramidal symptoms such as myotonia, dystonia, tremor and cortical dysfunction such as apraxia, heterosensory phenomenon, cortical sensory loss, myoclonus, aphasia^[1]。 Here we analyze the clinical manifestations of 4 patients with CBS to further understand the clinical features and neuroimaging findings of CBS.

In the Multi-Ethnic study of atherosclerosis (MESA), the prevalence of paroxysmal supraventricular tachycardia in the population is 2.25 per 1 000 people, and atrioventricular nodal reentrant tachycardia (AVNRT) is a common type of arrhythmia in supraventricular tachycardia, accounting for 20-30%^[1]。 Radiofrequency catheter ablation (RFCA) has become a type I therapeutic method because of its radical effect^[2]。 Traditional radiofrequency ablation needs to be performed under radioscopy. With the invention and perfection of mapping system, the amount of radiation in radiofrequency ablation gradually decreases. Our center carries out radiofrequency ablation guided by the three-dimensional electric field navigation system Ensite NavX (St. Yoda Company, USA), and maps the distribution area of endocardial His bundle during the operation. The application of it in radiofrequency ablation of atrioventricular nodal reentrant tachycardia is summarized as follows.

A 24-year-old female was admitted to Peking Union Medical College Hospital on April 1, 2016 due to fever and joint pain for more than 1 year and involuntary limb movement for 4 months. On 13 December 2014, the patient developed fever, with a maximum body temperature of 40 ℃, accompanied by swelling and pain in the joints of both hands, cough, a small amount of sputum, no symptoms such as rash, oral ulcer, hair loss and photosensitivity, and the local hospital checked the peripheral blood white blood cells 2.14×10⁹/L, hemoglobin 56 g/L, platelets 7×10⁹/L; Coombs test (+); Antinuclear antibody (ANA) 1:320, homogeneous, cytoplasmic; Activated partial prothrombin time (APTT) was 72.4 s, which could not be corrected by correction test. Chest CT showed frosted glass-like changes in both lungs and pleural effusion. Considering "connective tissue disease, alveolar hemorrhage and severe pneumonia", mechanical ventilation, broad-spectrum antibiotics against infection, intravenous injection of gamma globulin 25 g once/d for 6 days, and blood transfusion for supportive treatment (cumulative plasma 1 000 ml, red blood cells 1 200 ml, platelets 5 U). After 1 month, the symptoms improved without complaining of any discomfort. In December 2015, there was no trigger for paroxysmal twitching in the corner of the right eye and the corner of the mouth, instability in holding objects in the right hand, involuntary rotation of the right ankle when walking, irregular, non-repetitive, uncertain, sudden stop, no fever, disorder of consciousness, limb rigidity and binocular gaze, no headache, nausea and vomiting, etc. Lumbar puncture examination was performed in the local hospital, and the cerebrospinal fluid pressure was normal, routine and biochemistry were normal, and there was no positive finding in etiology. Cranial MRI plain scan + enhancement showed no obvious abnormalities. Considering "dystonia?", haloperidol 2 mg 3 times/d and oxiracetam 0.8 g 3 times/d were given, and the symptoms partially improved. The patient spontaneously discontinued the medication in February 2016. Mar 05, 2016 Again there was twitching in the corners of the mouth, wrist twisting, finger waving, and obvious in the left limb.

A 54-year-old female was seen for 7 years due to symmetrical polyarticular swelling and pain, mainly involving both metacarpophalangeal joints (MCP), proximal interphalangeal joints (PIP), both wrists and shoulder joints. There was no obvious morning stiffness, and the joint symptoms were obvious when the weather changed. Rheumatoid factor (RF) was negative after multiple examinations outside the hospital. Since the onset of the disease, the symptoms were alleviated when oral methotrexate (MTX), tripterygium wilfordii and leflunomide were administered, and hydroxychloroquine, tripterygium wilfordii and prednisone 10 mg were administered orally. After 3 months of treatment, the patient developed a left femoral fracture while going out to exercise, and was diagnosed as "osteoporosis". After the surgical treatment of femoral fracture, prednisone was stopped and oral hydroxychloroquine and tripterygium wilfordii continued. The patient's joint swelling and pain were not relieved obviously and ulnar deviation of both hands gradually appeared. Three years ago, leflunomide 10 mg once/d and methotrexate 10 mg once/week were added orally, but the disease control was still not ideal. When the weather changed, the joint symptoms were obvious, occasionally accompanied by fever, mainly moderate to low-grade fever, mostly transient, and could be relieved by itself without antipyretic drugs. Due to poor control of repeated joint swelling and pain, he went to Peking University International Hospital on June 8, 2015. Past history: Subtotal gastrectomy for gastric cancer in 2002, subtotal small intestine resection for intestinal obstruction and necrosis in 2009, and internal fixation of fracture for femoral fracture in 2011. Physical examination: The skin and palpebral conjunctiva were pale, a surgical incision scar about 30 cm long from the xiphoid process to the midline of the abdomen at the pubic symphysis was visible in the abdomen, the ulnar side of both hands was deviated, the left wrist joint, metacarpophalangeal joint (MCP) 2~3, proximal interphalangeal joint (PIP) 2~3, distal interphalangeal joint (DIP) 1 was swollen and tender, and the right wrist joint, PIP 2~5, DIP 1 was swollen and tender; Left PIP2, shoulder, ankle, DIP1 tenderness, right shoulder, ankle, DIP1 tenderness. After admission, the dynamic erythrocyte sedimentation rate was 23 mm/1 h, and the C-reactive protein (CRP) was 35.03 mg/L. Three rheumatoid items [anti-cyclic citrulline peptide antibody (CCP), anti-keratin antibody (AKA) and anti-perinuclear factor antibody (APF)] and rheumatoid factor were negative. Combined with the patient's medical history and physical examination, the patient's joint swelling and pain were not well controlled, and the patient's diagnosis of rheumatoid arthritis was clear. However, in view of his medical history of short bowel syndrome (after intestinal resection), oral methotrexate was adjusted to intramuscular injection of 10 mg/week, and leflunomide 20 mg once/d and hydroxychloroquine 200 mg twice/d continued to be administered orally to control the progression of rheumatoid arthritis. Only tocilizumab 400 mg was given intravenously once, and the patient stopped using it voluntarily because there was no obvious effect. In the past 1 year, the patient only took oral leflunomide, hydroxychloroquine combined with methotrexate intramuscular injection of 10 mg once/week, and the joint swelling and pain were significantly relieved.

Malignant tumors are major diseases that seriously threaten human life. According to the analysis of incidence and death of malignant tumors in my country in 2011 published in 2015, the results show that there are about 3.37 million new malignant tumor patients in my country^[1]。 At present, chemotherapy, radiotherapy and surgery are still the main treatment for tumor, among which chemotherapy is one of the main methods for treating tumor. In tumor chemotherapy or targeted therapy, there are large individual differences in both efficacy and toxicity. The reasons for individual differences are multiple factors, such as gender, age, height and weight, but it has been shown that the main reason for individual differences in drug response is genetic polymorphism^[2]。 For example, the genetic situation of tumor cells (somatic cells) is largely related to the efficacy of drugs, and the genetic situation of patients (germline) affects the exposure of drugs and the degree of adverse reactions.

Orthopedic endoimplants are widely used in various types of orthopedic surgeries, from limb fractures in trauma and orthopedics, joint replacement in joint surgery, osteotomy and orthopedics in spine surgery, fusion and fixation, and even fixation after tumor resection of various bones in the whole body, all of which are inseparable from the fixation of endoimplants.