2018年 · 第98卷第03期

Antibody-mediated rejection (AMR) is the most important risk factor affecting the long-term survival of transplanted kidneys. The key is the production and effect of donor-specific antibodies (DSA), especially the newborn DSA (dnDSA) after surgery. Recently, some new progress has been made in international research on risk stratification of dnDSA, the relationship between postoperative dnDSA and postoperative diagnosed AMR, the relationship between intragraft dnDSA and rejection, and how to prevent dnDSA.

Rehabilitation medicine is an important part of modern medicine, and it plays a significant role in the functional recovery of skeletal and muscular diseases. A large number of studies have proved that orthopedic rehabilitation can effectively speed up the rehabilitation process of patients, improve their function and significantly reduce the disability rate^[1,2,3,4]。 Of the 135 common diseases in humans, 106 are associated with bones and joints^[5]。 The incidence of orthopedic diseases is high, which is extremely harmful to human health and brings a great burden to society and families. Strengthening the clinical and rehabilitation treatment of orthopedic diseases is extremely important for restoring the body function of patients and improving their quality of life.

The patient was a 54-year-old female. He was admitted to hospital for "repeated epigastric pain for 3 months and another week". The patient developed pain under the xiphoid process of the upper abdomen 3 months ago, which was severe. The pain did not radiate to the lower back, there was no nausea and vomiting, and there was no fear of cold and fever. It improved after symptomatic treatment. Thereafter, abdominal pain recurred and no further treatment was performed. One week ago, the pain under the xiphoid process appeared again, the nature was the same as before, and the degree was significantly worse than before, accompanied by chills and fever. Physical examination: body temperature 38.5 ℃, heart rate 100 beats/min, breathing: 19 beats/min, blood pressure 115/75 mmHg (1 mmHg =0.133 kPa), slight abdominal swelling, mild tenderness on the right side of the xiphoid process in the upper abdomen, no rebound pain, and no obvious mass. Laboratory test: white blood cell count 11.9×10⁹/L, neutrophils 77.8%, lymphocytes 12.9%, hemoglobin 108 g/L, high-sensitivity C-reactive protein 128.7 mg/L. Upper abdominal enhanced CT examination: plain scan showed a patchy low-density shadow in the S3 segment of the liver, about 3.4 cm ×3.7 cm in size, with unclear boundary, linear osteoid dense shadow at the edge of the lesion, blurred fat space between liver and stomach, unclear structure of gastric antrum (large curved side), slight localized thickening of gastric wall, and no clear free gas accumulation shadow in the abdominal cavity; The edge of the lesion showed thin line-like annular continuous enhancement, and a low-density ring was seen between the lesion and the normal liver parenchyma. There was no obvious enhancement in the low-density area inside the lesion. Maximum density projection (MIP) and volume reconstruction (VR) techniques clearly showed the morphology of fish bone, the relationship with abscess cavity and the vague liver-stomach fat space (Figure 1、Figure 2、Figure 3)。 Two days after admission, laparoscopic exploration was performed: a local abscess was formed in the left lateral lobe of the liver and the round ligament, with an area of about 5 cm ×8 cm. The abscess cavity was incised and the pus was washed. A bone fish bone about 3 cm long was seen in the abscess cavity. After the foreign body was removed, part of the abscess cavity wall was removed, a drainage tube was placed, and suture closed. The patient recovered well after surgery and was discharged on day 9.

A 34-year-old woman was admitted due to intermittent numbness of both lower limbs for 3 months, aggravated with numbness of both upper limbs for 20 d. Physical examination: The muscle tone of the limbs was normal, the superficial sensation of both lower limbs was reduced, and the physical examination of the remaining nervous system showed no obvious abnormalities, and there was no family history. MRI of cervical vertebra showed: multiple clockwork-shaped and nodular abnormal signals were seen in the spinal cord at the level of cervical 5 and 6 vertebrae bodies, cervical 7 to thoracic 1 discs to thoracic 4 to 5 discs, T₁WI showed isointensity, slightly high intensity and high intensity, T₂WI and lipid pressure images showed high and low signal, and the intraspinal lesions at the level of thoracic vertebral body were enhanced after enhanced scan (Figure 1)。 The preoperative diagnosis was: cervical intramedullary cavernous hemangioma complicated by syringomyelia. Posterior median approach was used for surgery. Metal markers on body surface were examined by MRI to locate the corresponding segments before operation, and the tumor was completely resected under electrophysiological monitoring. Syringomyelia was not intervened, and no obvious abnormalities were found in intraoperative electrophysiological monitoring. Pathological diagnosis: spinal cord cavernous hemangioma (Figure 2)。 Postoperative physical examination: numbness of the limbs was relieved, and the upper limbs were relieved more obviously. MRI reexamination within 72 h after surgery showed complete resection of the lesion and remission of syringomyelia. MRI of cervical spine was performed 5 months after operation (Figure 3), syringomyelia was largely relieved, and there was no numbness in the limbs during physical examination.

Epilepsy is a clinical syndrome of abnormal synchronous discharge of brain neurons caused by various reasons, which is characterized by episodic, transient and repetitive. There are about 10 million people with epilepsy (PWE) in China, and about 400,000 new cases are added every year. With the development of urbanization, China's motor vehicles have grown rapidly. According to the statistics of the Traffic Management Bureau of the Ministry of Public Security (January 2017), by the end of 2016, there were 290 million motor vehicles and more than 310 million car drivers in China. More and more PWE and clinicians will face the confusion of epilepsy and driving. This article combines the latest research and national regulations to elaborate on epilepsy and driving.

Kidney transplantation is the best choice for the treatment of end-stage renal disease, but the shortage of donors greatly troubles clinicians and patients with end-stage renal disease^[1]。 At present, the source of organ transplant donors in China is mainly organ donation (DCD) after citizens' death, which has long thermal ischemia time^[2,3]It is easy to cause delayed recovery of renal function (DGF) after renal transplantation. DGF is a common complication after renal transplantation, and the main clinical manifestations are oliguria, anuria, and serum creatinine continuously or slowly decreases. The diagnostic criteria for DGF were: oliguria or anuria after surgery, requiring resumption of hemodialysis within the first week; Or serum creatinine value>400 μ mol/L on postoperative day 7 although hemodialysis was not resumed^[4]。 Therefore, how to effectively reduce the incidence of DGF and reduce the postoperative cost of patients is an urgent problem to be solved.

Pelvic and/or para-abdominal aortic lymph node dissection is an indispensable and important part of gynecological tumor staging surgery or tumor cytoreduction surgery. Lymphocyst is one of the most common complications after lymph dissection. Although most lymphocyst is asymptomatic but found during postoperative follow-up, larger lymphocyst often produces compression symptoms and affects the postoperative quality of life of patients. Once complicated with infection, it may be complicated with sepsis, hydronephrosis, thrombosis and other serious complications, which are life-threatening, and delay the related adjuvant treatment after surgery, which affects the prognosis. The occurrence of lymphocyst is related to various factors such as the scope and number of lymph node resection during operation, the operation mode and the application of energy instruments, the management of pelvic floor peritoneum and drainage during operation, and postoperative adjuvant therapy. This article reviews the relevant progress at home and abroad, aiming at exploring the risk factors and protective factors of lymphocyst. By strengthening the prevention and treatment measures of lymphocyst, it is beneficial to reduce the incidence of lymphocyst after gynecological tumor operation, reduce related complications, and enable timely and standardized postoperative adjuvant therapy, so as to improve the survival rate and quality of life of gynecological tumor patients.