2023年 · 第61卷第12期

With the aging of China's population structure, the number of patients undergoing total knee arthroplasty (TKA) continues to grow. According to reports, from 2011 to 2019, China's knee replacement entered a period of rapid growth, with an annual growth rate of 27.43%^［1］。 At present, the postoperative hospital stay of TKA patients is only 3~5 days, and home rehabilitation is the main one after discharge, which is of great significance to follow up patients after discharge^{［2, 3, 4］}。 The intelligent follow-up system has been widely used in prognostic follow-up of various diseases, and can provide the functions of establishing follow-up questionnaires and scales, setting up follow-up plans and tasks, reminders, data statistics, etc., which is convenient for medical staff to obtain follow-up information, improve follow-up efficiency, improve clinical symptoms and improve patients' quality of life^{［5, 6］}。 Our team has been using the intelligent follow-up system for patient follow-up since January 2022. Now, using the follow-up data as the research object, we summarize and analyze the application of the intelligent follow-up system and the recovery of knee function of patients in the early stage after TKA.

The patient, a 63-year-old male, was admitted to our hospital on January 10, 2022 due to "sudden upper abdominal discomfort for 2 days". The patient was seen in another hospital 2 days ago due to intermittent dull pain in the left upper abdomen, and his blood pressure was 160/110 mmHg (1 mmHg =0.133 kPa). CT findings showed that there was a proximal renal abdominal aortic aneurysm combined with thoracic aorta and bilateral iliac artery aneurysms. For further treatment, we came to the emergency department of our hospital. He has suffered from hypertension for more than 40 years. He underwent coronary artery bypass grafting due to coronary heart disease and acute myocardial infarction 10 years ago. An abdominal aortic aneurysm was discovered 5 years ago. At that time, the maximum diameter of the aneurysm was about 50 mm, and it was not treated and reviewed regularly. Physical examination: Body temperature 36.1 ℃, heart rate 77 beats/min, blood pressure 127/94 mmHg. A 10 cm ×15 cm pulsatile mass was palpable in the abdomen, and the arteries of the extremities pulsed well. CT angiography showed that thoracic aortic aneurysm with penetrating ulcer, the maximum diameter of the tumor was 55 mm, the diameter of the aorta at the left subclavian artery was 34 mm, and the diameter of the aorta at the distal end of the tumor was 26 mm (Figure 1A). The maximum diameter of the abdominal aortic aneurysm is 73 mm, the superior mesenteric artery is 3 mm from the left renal artery, 15 mm from the right renal artery, the length of the inferior margin of the right kidney from the tumor body is 5 mm, the diameter of the abdominal aorta at the level of the superior mesenteric artery is 23 mm, and the neck angle of the tumor is 80°. Bilateral common iliac artery aneurysms with mural thrombus, the maximum diameter of the aneurysm is 39 mm (left common iliac artery) and 32 mm (right common iliac artery), respectively, and bilateral internal iliac artery aneurysms are combined (Figures 1B-1F).

The patient, a 53-year-old female, was seen in Zhejiang Provincial People's Hospital on September 19, 2019 due to "epigastric pain for 1 month". The patient developed upper abdominal pain without obvious trigger 1 month ago, which was distended pain, mild degree, no progressive aggravation, and no other symptoms. External gastroscopy revealed chronic erosive gastritis, biopsy revealed signet ring cell carcinoma. Physical examination: swollen lymph nodes were accessible in the neck and groin area, with a maximum diameter of about 2.0 cm, no tenderness, clear boundaries and good movement. Soft abdomen, no tenderness and rebound pain, and no other positive signs. Weight loss of 5 kg since onset. Admission diagnosis: gastric malignancy. After admission, alpha-fetoprotein 6.5 μ g/L, carcinoembryonic antigen 1.3 μ g/L and CA19-9 2.5 U/L were checked. Positive occult blood test in stool. PET-CT showed that the distribution of flaky tracers in the stomach wall at the stomach body and angle was increased, with a maximum uptake value of 4.8, bilateral neck (size about 1.0 cm ×1.2 cm, maximum uptake value 7.5), bilateral clavicular area (size about 1.1 cm ×2.0 cm, maximum uptake value 8.7), bilateral diaphragmatic foot space, liver and stomach space, front of the pancreatic head (size about 2.2 cm ×2.5 cm, maximum uptake value 9.1, squeezing the head and neck of the pancreas backward), under the pancreatic body (size about 1.5 cm ×2.0 cm, maximum uptake value 11.1), retroperitoneal (size about 1.7 cm ×1.2 cm, maximum uptake value 11.0), around the left iliac vessel (size about 1.7 cm ×1.2 cm, maximum uptake value 11.0), bilateral inguinal area (1.0 cm ×1.2 cm, maximum uptake value 6.0), multiple nodules of different sizes were seen, and the distribution of tracers was increased to varying degrees (Figure 1). The results of abdominal enhanced CT examination showed that the stomach wall on the small curved side of the stomach body was slightly thickened; No metastases were found in the liver and abdominal cavity; Multiple lymph nodes were enlarged around the pancreas, retroperitoneal, and left inguinal area, which were considered malignant tumors, and lymphomas were to be ruled out. The results of pancreatic MRI showed that there were multiple enlarged lymph nodes around the pancreas and retroperitoneum, with the largest diameter of 4.26 cm, and metastatic lymph nodes were considered. Multidisciplinary diagnosis and treatment discussion: At present, the pathological diagnosis of gastric cancer is clear, and there are multiple swollen lymph nodes around the stomach, retroperitoneum, supraclavicle and groin. It should be clear whether gastric cancer is metastatic or primary tumor, and lymph node puncture or resection biopsy is recommended. With the consent of the patient and family, ultrasound-guided right supraclavicular lymph node puncture biopsy and left inguinal lymph node resection biopsy were performed on September 24 and October 11, 2019, respectively. The results of pathological examination showed that the right supraclavicular lymphoid tissue was proliferative lesion, and lymphoma could not be excluded. The "left inguinal lymph node" is a lymphoproliferative lesion. Immunohistochemical staining results: CD19 (+), Bcl-6 (partial +), CD43 (+), cyclinD1 (-), CD23 (+), Ki67 (+, 10%), Bcl-2 (+), CD3 (T cell +), CD20 (+), CD10 (+), CD5 (+), CD79a (+). Molecular test results: Epstein-Barr virus test (-). Non-Hodgkin's lymphoma is predisposed, follicular lymphoma is more likely (Figure 2).

Academician Wang Zhonghao, member of Jiusan Society, academician of Chinese Academy of Sciences, founder of vascular surgery in China, chief physician, professor and doctoral supervisor of Xuanwu Hospital of Capital Medical University, and consultant of the 12th editorial board of Chinese Journal of Surgery, died in Beijing at 12: 58 on November 3, 2023 at the age of 86 due to ineffective treatment.