2016年 · 第96卷第20期

Organ transplantation is the most effective method for treating various end-stage diseases of organs. However, in recent years, the shortage of organs for transplantation has become increasingly serious, which makes expanded criteria donor (ECD) organs more and more widely used in clinical practice. Thermal ischemic injury of ECD organs is more severe, organ viability is reduced, and the probability of primary non-function (PNF) of organs after transplantation is significantly increased. extracorporeal membrane oxygenation (ECMO) can effectively shorten the time of organ thermal ischemia and promote the recovery of organ function through mature cardiopulmonary bypass support measures^[1]。 At present, ECMO technology has gained more and more experience in the process of ECD organ protection, effectively expanding the donor utilization rate, improving the success rate of transplantation and the long-term quality of life of patients after transplantation.

A 39-year-old male was admitted to the hospital on October 9, 2014 due to "erythematous papules and pustules in the limbs for 2 months, swelling and pain in the right lower limb with fever for 1 week". The patient self-complained that in August 2014, there was erythema, papules and pustules on the skin of the limbs without obvious inducement, accompanied by itching, and ulceration, erosion and exudation after scratching. Treated as eczema in the local hospital, the rash improved after treatment with dexamethasone 10 mg/d, vitamin C and calcium gluconate. On September 26th, I began to have repeated fever, with the highest body temperature of 39.8℃, accompanied by general swelling, which was obvious in the limbs. At the same time, the swelling of the right ankle joint was aggravated with flushing pain, and the right foot was difficult to walk. After attending the emergency department of our hospital, he was admitted to the dermatology department. Considering the possibility of vasculitis, he was given dexamethasone 10 mg/d to suppress the immune response, and piperacillin and sulbactam combined with levofloxacin to fight infection. On the third day of admission, the patient developed obvious chest tightness and chest pain. Emergency blood gas analysis: PO₂65.2 mmHg (1 mmHg =0.133 kPa), PCO₂36.3 mmHg. CT pulmonary angiography (CTPA) showed multiple embolism in both pulmonary arteries (Figure 1)； Mild inflammation of the posterior basal segment of the lower lobes of both lungs; The pleura was mildly thickened on both sides, and pulmonary embolism was diagnosed and transferred to respiratory medicine. Smoking for more than 20 years, about 40 cigarettes/d.

A 26-year-old female developed reddish pimples on both sides of her face and nose at the age of 3, involuntary laughter at primary school, and epileptic symptoms at the age of 17, which showed brief loss of consciousness and limb twitching. After taking sodium valproate regularly for treatment, 0.4 g three times a day, self-complaint epilepsy symptoms still have irregular seizures. Polycystic kidney was discovered in 2008. On April 9, 2008, he underwent decompression and decompression of right polycystic kidney in our hospital. Postoperative pathology showed fibrous adipose tissue and smooth muscle bundle under the microscope (right polycystic kidney), with cyst wall-like changes in some areas and cubic epithelial covering, which can conform to benign cystic lesions, but angiomyolipoma cannot be completely excluded. Results of enzyme-labeled immunohistochemical staining: smooth muscle actin (SMA) positive (+), desmin (DES) (+), CD68 negative (-), S-100 (-), CD117 (-), CD34 vessel (+), vimentin (VIM) (+). Regular follow-up after surgery, creatinine increased to 800 μ mol/L 1 1/2 years ago, considering renal insufficiency, uremic stage. Maintenance hemodialysis treatment in local hospital every Tuesday, Thursday and Saturday. In 2013, the creatinine was maintained at about 800 μ mol/L before hemodialysis, and there was anuria. He was admitted to hospital for renal allograft.

A 19-month-old male was admitted to another hospital due to "painless mass on the left side of the scrotum for 1 month". B-ultrasound showed left testicle occupying space, right testicle cystic-solid occupying space, and magnetic resonance image (MRI) showed left testicle occupying space lesion, considering tumor of reproductive origin (FIG. 1A)。 Laboratory examination showed that alpha-fetoprotein (AFP) was 2 122.3 μ g/L (normal range: 0-5.3 μ g/L), and the preoperative diagnosis was "yolk sac tumor of left testis, occupying space of right testis". The parents requested that only the left side be operated and the right side be observed for treatment. Radical left orchiectomy was performed, and paraffin section revealed "yolk sac tumor of left testis" (FIG. 2A，Figure 2B), postoperative diagnosis of "left testicular yolk sac tumor (stage I), right testicular occupying space", no further treatment such as chemotherapy. After 1 month of follow-up visit, AFP returned to normal. After that, AFP and B-ultrasound were followed up in local hospitals every 45 days or so, and AFP examinations were all in the normal range; B-ultrasound examination showed no obvious changes in the right testicular mass.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive pulmonary fibrotic disease with an irreversible course and is the most common and severe type of idiopathic interstitial pneumonia^[1]。 According to the statistics of Europe, America and Japan, the incidence of IPF is (0.22~17.40) /100,000^[2]。 The disease is more common in people aged 50-70, and is more common in men than in women; The main clinical manifestation is progressive dyspnea, and the histopathological and imaging manifestations are common interstitial pneumonia; A definitive diagnosis requires the exclusion of pulmonary fibrosis secondary to known etiology, combined with clinical manifestations, pulmonary function and imaging findings, sometimes with the help of pathology. The pathogenesis of IPF is unclear, the treatment is limited, and the prognosis is poor^[3]。 At present, it is believed that the disease is caused by repeated epithelial cell damage and dysregulation of repair process, fibrosis of lung tissue and excessive extracellular matrix deposition, resulting in the loss of normal structure of lung parenchyma, decreased lung compliance and impaired gas exchange function. The primary link may be the damage and abnormal activation of alveolar epithelial cells (AEC). The role of AEC in the pathogenesis of IPF is summarized as follows.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonatal period. The disease has acute onset, rapid progression and poor prognosis. It is one of the main causes of death of premature infants, and has become a difficult disease in neonatology. With the increase of the number of premature infants and the prolongation of survival time, the incidence of NEC increases. Some multi-center studies in the United States have shown that the incidence of NEC in very premature infants and ultra-premature infants is 7% ~11%^[1,2]It is lower in Canada and some European countries^[3,4,5]。 The mortality rate of NEC reaches 20% ~40%^[1,6,7]。 Even if they survive, complications such as intestinal stenosis, short bowel syndrome, repeated sepsis, dependence on parenteral nutrition may occur, and the mortality rate of severe cases and the incidence of long-term neurodevelopmental disorders are higher^[8]。 Therefore, it is of great significance to prevent NEC in premature infants. Breastfeeding, prevention and control of infection, scientific enteral feeding, etc. have good effects on the prevention of NEC. The imbalance of intestinal flora is an important cause of NEC^[9]Oral probiotics in premature infants may have important implications for the prevention of NEC.