2017年 · 第97卷第17期

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.

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.