2018年 · 第98卷第06期

At present, it is mostly believed that heparin was first discovered by McLean and Howell. In the 1920s, heparin began to be commercially used, but because of its insufficient purity, a series of adverse reactions occurred. In 1933 Banting and Best discovered heparin in the liver of cattle and conducted tests in Canada to improve its purity. At the same time, Jorpes of Sweden has also discussed the improvement of purification technology. After Moloney and Taylor discovered the method of mass production of heparin in the 1940s, heparin was gradually widely used as an anticoagulant in surgery and dialysis treatment. With the further understanding of the site of action between heparin and antithrombin, heparin is broken down into smaller fragments, which can bind antithrombin site more effectively and provide better anticoagulant effect. These small heparin fragments are low molecular weight heparin born in 1970s^[1]。

At present, the distribution of medical resources in China is uneven, the structure is unreasonable, and the differences in medical technology and medical service level are large, which affects the fairness and efficiency of medical services to a certain extent. At the same time, the excessive concentration of high-quality medical resources also makes the development of hospitals themselves limited. To realize the fairness and accessibility of medical services, achieve the goal of health for everyone, solve and improve the problem of difficulty in seeing a doctor, medical cooperation in large public hospitals with high-quality medical resources is one of the effective ways to solve the above problems. However, there are many risks in foreign cooperation, such as financial risk, legal risk, ethical risk, personnel risk, etc. Now, the legal risks involved, such as legal risks caused by behavior and personnel, are discussed as follows.

Heparin-induced thrombocytopenia (HIT) is an adverse reaction of heparin mediated by antibodies that occurs during the application of heparin drugs. Clinically, the main manifestation is a decrease in platelet count, which can lead to venous and arterial thrombosis, and even death in severe cases^[1,2]。

The patient was a 19-year-old female with a body weight of 63 kg. He was admitted to hospital due to 33 weeks of menopause and chest tightness for 10 days. Prehospital ultrasonography revealed: congenital heart disease (periventricular septal defect 2.5 cm, bi-directional shunt), severe pulmonary hypertension (116 mmHg, 1 mmHg =0.133 kPa). Ultrasound diagnosis: Eisenmanger's syndrome. With "congenital heart disease (ventricular septal defect), pregnancy-related conditions (pregnancy 1 delivery 0 pregnancy 33^＋4Weeks), Eisenmanger syndrome "admitted to hospital. No previous physical examination or prenatal examination, no history of cardiac disease recorded.

The patient, a 50-year-old female, was admitted to Peking Union Medical College Hospital on June 2, 2017 due to "myasthenia for more than 4 years, and blood calcium and blood creatinine were found to be elevated for more than 1 month". In 2013, the patient began to intermittently develop weakness in both lower limbs after bending over to lift heavy objects. It usually appeared after walking for more than ten minutes, and could return to normal after rest. Creatine kinase (CK) 270 U/L was examined in other hospitals, and electromyography showed myogenic changes. Polymyositis was not excluded and was not treated. In October 2016, there was weakness in both upper limbs, with the proximal end, which showed that I couldn't pick up a kettle, but I could pick it up. The weakness of the lower limbs was aggravated than before, and I needed to support the railings when going up and down stairs. Deny dysphagia, choking and coughing after drinking water, dyspnea, fever, rash, joint and muscle pain. CK was 133 U/L, serum creatinine was 150 μ mol/L, and serum calcium was 3.25 mmol/L. Electromyography showed myogenic lesions, slowed nerve conduction velocity (NCV) in both lower limbs, and normal repetitive electrical nerve stimulation (RNS); Ultrasound: hypoechoic nodules in the suprasternal fossa, not excluding deformed and enlarged lymph nodes, both cervical lymph nodes revealed, considering the possibility of paraneoplastic syndrome. Visit our hospital for further diagnosis and treatment. The patient had photosensitivity, dental caries, denied subcutaneous nodules, dry mouth, dry eyes, and mucosal ulcers. Since the disease, there has been no obvious change in appetite, bowel movement as usual, and weight loss of about 5 kg. Past history: More than 20 years ago, sputum smear was positive for Mycobacterium tuberculosis, diagnosed as "tuberculous pleurisy and bronchiectasis", and non-standard anti-tuberculosis treatment; He was diagnosed as "vitiligo" more than 10 years ago. Deny smoking, drinking history, marriage, childbirth, menstrual history, family history is not special.

The patient, a 72-year-old man, was admitted to the Department of Nephrology of Beijing Hospital on May 9, 2017 mainly due to "the discovery of elevated serum creatinine for 15 years, sudden abdominal pain with significantly elevated serum creatinine for 6 days". The patient found that blood creatinine was elevated 15 years ago, fluctuating from 90 to 130 μ mol/L, and was treated with Baoshenkang orally regularly. Serum creatinine was 89.5 μ mol/L when he was hospitalized due to sudden cerebral infarction 7 days ago. Six days ago, he had sudden distension and pain in the left lower abdomen, accompanied by cessation of exhaustion and defecation, transient low fever, and the highest body temperature was 37.6 ℃. Blood routine, coagulation function was normal, and blood creatinine was 121.5 μ mol/L. The other hospital considered "acute intestinal obstruction", gave fasting, anti-infection and other treatments, and the fever and abdominal pain improved. The application of Kaiselu can have a small amount of exhaust and defecation, and was transferred to the emergency department of our hospital 2 days ago. Blood test routine: white blood cells 23.31×10⁹/L, neutrophils 92%. Blood biochemistry: serum creatinine 283 μ mol/L, urea nitrogen 17.84 mmol/L, lactate dehydrogenase (LDH) 1 286U/L, C-reactive protein (CRP) 157 mg/L; Procalcitonin (PCT) 0.176 μ g/L. Electrolytes and myocardial enzymes were normal, N-terminal B-type pronatriuretic peptide (NT-proBNP) 10 434 ng/L, D-dimer 0.879 mg/L, gastric occult blood (+ +). Urine routine: urine protein 0.3 g/L, red blood cells 0~1/HP. Considering "sepsis", meropenem 0.5 g/12 h combined with linezolamide 600 mg/12 h intravenous drip for anti-infection, thrombin 5 000 U/time, and oral hemostasis once/8 h for 2 days. Echocardiography: Hypertrophic cardiomyopathy (asymmetry), horizontal obstruction of the middle papillary muscle of the left ventricle, enlargement of the left atrium, ejection fraction 60%. Renal artery B-ultrasound: blood flow resistance index (RI) of left renal artery was increased (0.79~0.80). Bedside chest radiograph: the heart shadow was significantly enlarged. Abdominopelvic CT showed no intestinal obstruction. After 2 days of emergency treatment, the patient's blood white blood cells and serum creatinine decreased compared with before, and the occult blood of gastric juice turned negative, so he was transferred to the nephrology ward. There was no oliguria or edema in the course of the patient's disease. Previous hypertrophic cardiomyopathy, diabetes, hypertension, persistent atrial fibrillation, underwent right nephrectomy 25 years ago for renal cyst.

Sponsored by China Human Organ Donation and Transplantation Committee and China Organ Transplantation Development Foundation, and hosted by Institute of Organ Donation and Transplant Immunity of Sun Yat-sen University and China Human Organ Distribution and Sharing Computer System, the China-International Organ Donation Conference was held in Guangzhou from December 16 to 17, 2017. The theme of this conference was "China's Organ Transplantation to the Center of the World Stage". More than 500 experts from home and abroad attended the conference, and more than 50 media, including Xinhua News Agency, CCTV, Central People's Broadcasting Station, China News Service, China Daily and People's Daily, participated in the recording and reporting of the conference. This conference is another important conference in the field of human organ donation and transplantation after the first China-International Organ Donation Conference held in the Golden Hall of the Great Hall of the People in October 2016. It aims to promote the standardization and legalization of organ donation and transplantation in China, declare the policies, regulations and work plans of organ donation and transplantation in China, discuss the outstanding problems of organ donation in China, and publicize the achievements of organ donation in China, so as to promote the development of organ donation and transplantation in China^[1]。