Objective To predict and analyze the potential suitable areas of the Guangxi characteristic medicinal plant Zanthoxylum nitidum(Roxb.)DC.in China under climate change;To provide reference for ecological conservation and artificial cultivation of Zanthoxylum nitidum(Roxb.)DC.Methods Based on the 49 pieces of geographical distribution information of Zanthoxylum nitidum(Roxb.)DC.in China,19 environmental factors,and the maximum entropy(MaxEnt)model,a species distribution model was constructed to predict and analyze the potential growth areas of Zanthoxylum nitidum(Roxb.)DC.under current and future climate change.Results Under the current climate change,the potential suitable areas of Zanthoxylum nitidum(Roxb.)DC.in China mainly depended on 4 environmental factors:precipitation in the coldest season(Bio19),precipitation in the warmest season(Bio18),precipitation in the driest season(Bio17),and average annual temperature(Bio1).Under the future climate change,the center of mass of the high suitable areas of Zanthoxylum nitidum(Roxb.)DC.will mainly migrate to the northeast and northwest,and the migration distance will range from 13.63 km to 153.95 km.Compared with the present,the stable and unchanged high suitable areas of Zanthoxylum nitidum(Roxb.)DC.under future climate change will be reduced to about 21.68%,and mainly distributed in southwest Guangxi,and these stable and unchanged areas will become the first choice for semi-artificial planting of Zanthoxylum nitidum(Roxb.)DC.Conclusion The results are helpful to provide scientific basis for formulating reasonable ecological conservation and artificial cultivation strategies to reduce the impact of climate change on the population spread of Zanthoxylum nitidum(Roxb.)DC.

One 51 years old man was admitted to the rheumatology department with a history of prominent eyes, headache and blurred vision for half year. The main manifestations included retrobulbar inflammatory pseudotumor and retroperitoneal fibrosis. He was initially diagnosed as granulomatosis with polyangiitis. Prednisone and cyclophosphamide were administrated and effective. New mass of dura mater and osteosclerosis presented during follow up. Finally Erdheim Chester disease(ECD) was diagnosed by biopsy and pathological examination. Vemurafenib, a v-raf murine sarcoma viral oncogenes homolog B1 (BRAF) inhibitor, 480 mg was given twice a day. The patient′s condition is stable and still in follow-up. Although ECD is a rare histiocytosis, clinicians should pay attention to its manifestations and differential diagnoses.

Unicompartmental knee arthroplasty(UKA) is an important surgical technique for the treatment of end-stage knee osteoarthritis, which has high requirement for the position and angle of the prosthesis. The application of three-dimensional(3D) printed in UKA reflects several characteristics such as accuracy,efficiency and safety,but the current research results show that there is still lack of consistency in the design of 3D printed guides and the standard of prosthetic position parameters. This article reviews the history, manufacturing requirements and process of 3D printed guides during UKA surgery, as well as the results of current clinical research. Whether 3D printed guides can safely and effectively improve the placement accuracy of inexperienced doctors during UKA surgery,and whether the long-term results are worthy of clinical promotion need further verification.

Unicompartmental knee arthroplasty(UKA) is an important surgical technique for the treatment of end-stage knee osteoarthritis, which has high requirement for the position and angle of the prosthesis. The application of three-dimensional(3D) printed in UKA reflects several characteristics such as accuracy,efficiency and safety,but the current research results show that there is still lack of consistency in the design of 3D printed guides and the standard of prosthetic position parameters. This article reviews the history, manufacturing requirements and process of 3D printed guides during UKA surgery, as well as the results of current clinical research. Whether 3D printed guides can safely and effectively improve the placement accuracy of inexperienced doctors during UKA surgery,and whether the long-term results are worthy of clinical promotion need further verification.

Objective:To explore the influence of lateral patellofemoral joint degeneration on the treatment of anteromedial osteoarthritis of knee joint by Oxford medial unicompartmental knee arthroplasty.Methods:The clinical data of 73 patients (73 knees) with knee osteoarthritis underwent unicompartmental knee arthroplasty at Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University from March 2016 to December 2017 were analysed respectively.There were 18 males and 55 females, aged (68.6±7.5) years(range: 53 to 89 years).The lateral patellofemoral joints of patients were evaluated by Ahlback grading system. Patients with Ahlback 0 andⅠ were in the non degenerative group (37 cases), and those with Ahlback Ⅱ and above were in the degenerative group (36 cases). Hospital for special surgery knee score(HSS) and the Western Ontario and McMaster Universities(WOMAC) osteoarthritis index, as well as the condition of kneeling, sit to stand movement, up stair and down stair were recorded. The data before and after operation were compared by paired sample t test, and the data between groups were compared by independent sample t test. χ 2 test was used for counting data. Pearson correlation analysis was used to compare the correlation between ahlback score, HSS and WOMAC osteoarthritis index. Results:The follow-up time was (35.1±6.6) months (range: 25 to 47 months).The knee function of the patients improved significantly after operation.The HSS score increased from 57.7±11.8 preoperative to 81.8±7.8 postoperative ( t=16.64, P=0.00) and WOMAC osteoarthritis index decreased from 48.9±13.4 preoperative to 15.6±8.8 postoperative ( t=20.48, P=0.00). There was no statistical difference in the change of HSS between the degenerative group and the non-degenerative group before and after surgery(27.5±12.2 vs. 22.5±12.3, t=-1.65, P=0.10) as well as the change of WOMAC osteoarthritis index(31.8±14.0 vs. 36.4±13.7, t=-1.35, P=0.18), but the lateral patellofemoral joint degeneration was related to inability to complete squats (χ 2=5.17, P=0.04) and sitting up (χ 2=7.22, P=0.01). Conclusion:The degeneration of lateral patellofemoral joint has no effect on the early functional recovery of patients with anteromedial knee osteoarthritis after Oxford medial unicompartmental knee arthroplasty.

Objective:To explore the influence of lateral patellofemoral joint degeneration on the treatment of anteromedial osteoarthritis of knee joint by Oxford medial unicompartmental knee arthroplasty.Methods:The clinical data of 73 patients (73 knees) with knee osteoarthritis underwent unicompartmental knee arthroplasty at Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University from March 2016 to December 2017 were analysed respectively.There were 18 males and 55 females, aged (68.6±7.5) years(range: 53 to 89 years).The lateral patellofemoral joints of patients were evaluated by Ahlback grading system. Patients with Ahlback 0 andⅠ were in the non degenerative group (37 cases), and those with Ahlback Ⅱ and above were in the degenerative group (36 cases). Hospital for special surgery knee score(HSS) and the Western Ontario and McMaster Universities(WOMAC) osteoarthritis index, as well as the condition of kneeling, sit to stand movement, up stair and down stair were recorded. The data before and after operation were compared by paired sample t test, and the data between groups were compared by independent sample t test. χ 2 test was used for counting data. Pearson correlation analysis was used to compare the correlation between ahlback score, HSS and WOMAC osteoarthritis index. Results:The follow-up time was (35.1±6.6) months (range: 25 to 47 months).The knee function of the patients improved significantly after operation.The HSS score increased from 57.7±11.8 preoperative to 81.8±7.8 postoperative ( t=16.64, P=0.00) and WOMAC osteoarthritis index decreased from 48.9±13.4 preoperative to 15.6±8.8 postoperative ( t=20.48, P=0.00). There was no statistical difference in the change of HSS between the degenerative group and the non-degenerative group before and after surgery(27.5±12.2 vs. 22.5±12.3, t=-1.65, P=0.10) as well as the change of WOMAC osteoarthritis index(31.8±14.0 vs. 36.4±13.7, t=-1.35, P=0.18), but the lateral patellofemoral joint degeneration was related to inability to complete squats (χ 2=5.17, P=0.04) and sitting up (χ 2=7.22, P=0.01). Conclusion:The degeneration of lateral patellofemoral joint has no effect on the early functional recovery of patients with anteromedial knee osteoarthritis after Oxford medial unicompartmental knee arthroplasty.

Total hip arthroplasty is currently an important surgical method for the treatment of hip diseases. The modular design of the head and neck taper facilitates the adjustment of limb length and femoral offset during surgery, however, complications such as wear, corrosion and looseness of the modular interface are also inevitable old problems. In recent years, with the changes in the design of prostheses, the trend that patients becomes younger and active, and the development of minimally invasive surgery, taper corrosion has again become a problem that needs to be solved and cannot be ignored, which is causing the attention of joint surgeons. There have been many studies on the complications associated with metal-on-metal prosthesis modular interfaces, such as increased metal ion level, taper corrosion and adverse local tissue reactions, while there are few studies on the complications of metal-on-polyethylene total hip arthroplasty, and metal-on-polyethylene prosthesis has similar problems such as increased local metal ion level and adverse tissue reactions caused by taper corrosion, which may also lead to complications such as prosthesis loosening, dislocation and fracture. Currently there are few reports about head and neck taper corrosion of metal-on-polyethylene prosthesis in China and there are still controversies about its manifestation and mechanism. In this paper, we summarized the above problems through literature reviewto expound the concept, research history, assessment methods, and incidence of metal-on-polyethylene prosthesistaper corrosion and the effect of material composition, diameter of the metal head, neck length, femoral offset, geometry of the taper, surgical factors, in vivo time, and patient factors on taper corrosion are analyzed. In summary, there are still many problems in the researches about the specific forming mechanism that have not been solved, thus it is very important for the prevention of taper corrosion: choosing the same material or ceramic material, avoiding overlarge diameter of the femoral head and femoral offset, avoiding too small taper degree, paying attention to the strength of tapping and cleaning of the taper are the current viable options.

Objective To investigate the factors affecting the efficacy of leflunomide combined with medium/low dose corticosteroids in the treatment of progressive IgA nephropathy (IgAN).Methods Clinical and pathological parameters were collected retrospectively in patients of primary IgAN with proteinuria＞ 1.0 g/24 h and chronic kidney disease (CKD) stage 1-3 treated with leflunomide combined with medium/low dose corticosteroids in Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University from Jan 2005 to Dec 2010.According to the treatment effects,patients were divided into complete remission group and non-complete remission group.The biochemical and pathological indexes of the two groups were compared.Results A total of 42 patients were included.The remission rates at 3,6,9 and 12 months were 62％,64％,67％ and 74％,respectively.Seventeen (40.5％) and fourteen (33.3％) patients achieved complete and partial remission after one-year treatment,and the remission rate remained stable within one year after withdrawal of drugs.The 24hour proteinuria was 1.50 (0.67,2.66) g,which was significantly reduced compared with the baseline 2.44 (1.36,3.74) g (P ＜ 0.01).The decrease rate was 31.3％.There was a slight decrease in proteinuriawithin one year after withdrawal of drugs.Estimated glomerular filtration rate (eGFR) remained stable during the treatment and a year of follow-up.No serious adverse event was observed during the followup period.Among 31 responder patients,6(19.4％) patients relapsed.Logistic multivariate regression analysis suggested that the degree of renal interstitial inflammatory infiltration was an independent predictor of complete remission with one-year treatment of leflunomide combined with medium / low dose corticosteroids (HR=0.067,95％ CI 0.008-0.535,P=0.011).Conclusions IgAN treated with leflunomide and medium/low dose corticosteroids can achieve remission in early stage,and the remission rate remains stable after withdrawal of drugs.It is a safe option for the treatment of IgAN.Renal interstitial inflammatory infiltration is an independent predictor of complete remission.

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB)is a commonly seen gastrointestinal emergency.Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB.Aims:To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Methods:Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic (ROC)curve (AUC).Results:Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived (P <0.01 ).The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0.785 (95% CI:0.743-0.828,P=0.000),0.765 (95% CI:0.693-0.837,P=0.000),0.835 (95% CI:0.703-0.966,P=0.005),respectively.The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0.812 (95%CI:0.775-0.848,P=0.000),0.870 (95%CI:0.811-0.930,P=0.000),0.784 (95% CI:0.614-0.954,P=0.017),respectively.Conclusions:Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB.Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.

Breast cancer is a group of diseases with considerable inner heterogeneity. Intrinsic subtyping has classified breast cancer into major subtypes, such as Luminal A, Luminal B, HER2-enriched, and basal-like breast carcinomas. This classification is based on the specific expression patterns of certain genes that effectively reflect each distinct biology and clinical outcome. Moreover, this classification is widely accepted and utilized. Epidemiological studies based on intrinsic subtyping shed a new light on breast cancer recognition. Traditionally validated risk factors showed substantial differences in their association with various intrinsic subtypes. The paradox of risk factors for breast cancer development generally exerting protective effects on patient survival has been observed. This phenomenon is highly likely caused by the heterogeneity among intrinsic subtypes. Future epidemiological studies on breast cancer should develop a further precise basis on the intrinsic subtypes, and this article will summarize the advances in epidemiology based on molecular subtyping of breast cancer.