2014年 · 第94卷第48期

Journal of Organ Transplantation (Transplantation) On April 27, 2014, Volume 97, Issue 8 published an article by Delmonico and eight other professors to our leaders in the form of an open letter: "China's Anti-Corruption Struggle in the Field of Organ Transplantation". Therefore, we express our views and positions on the issues involved in organ transplantation in China.

The patient, an 85-year-old male, was admitted to the hospital on April 2, 2014 due to intermittent epistaxis for more than 5 years, general ecchymosis for more than 4 years, and aggravation for more than 2 months. The patient had persistent epistaxis without obvious trigger since 2008, and finally stopped bleeding after tamponade and compression by otolaryngology. Since then, patients will have epistaxis 1 to 3 times almost every winter, and all of them need tamponade to stop bleeding. Since 2009, patients have intermittently developed post-bump skin ecchymosis, which is more common in the limbs, with different sizes and no obvious pain, and no diagnosis and treatment have been performed. In February 2014, the patient developed large ecchymosis on his left hand, about 4 cm in diameter, after bumping. Later, due to braces falling off and injury, blood blisters with a diameter of about 2 cm appeared on the tongue, and the pain was obvious, which affected eating. In the same month, there were patches of ecchymosis in the left popliteal fossa, posterior femur, hip and waist without obvious trigger. Routine blood test in other hospitals: white blood cell count normal, hemoglobin (HGB) 103 g/L, mean red blood cell volume (MCV) 95.4 fl, platelet 80×10⁹/L; Ferritin normal (345.2 μ g/L); Coagulation function: prothrombin time (PT) 13.5 s increased (↑), activated partial thromboplastin time (aPTT) 45.9 s ↑, thrombin time (TT) 20 s ↑; Liver and kidney function: creatinine 204 μ mol/L↑, total bilirubin (TBil) 33.3 μ mol/L↑, direct bilirubin (DBil) 20.4 μ mol/L↑, and symptomatic treatment for hemostasis. On March 25, 2014, the patient accidentally fell from bed and landed on his left hip. The next day, the left hip mass, swelling and pain appeared, and the skin gradually appeared bruised. Admitted to our hospital as "cause of bleeding tendency to be investigated". Since the onset of the disease, there was no fever, night sweats, fatigue, dizziness, amaurosis, palpitations, decreased activity tolerance, acceptable spirit, sleep and diet, normal defecation, and no obvious change in weight. Past history: "Pulmonary tuberculosis" was found in 1955 and recovered after treatment. Discovery of atrial fibrillation in 1975. In 2009, creatinine was found to be elevated (the details are unknown), and no diagnosis and treatment were performed. In 2011, he went to an outside hospital for "left pleural effusion and left lower lobe nodules". After thoracic puncture and drainage, the effusion absorption disappeared, and benign inflammatory lesions were considered. Discovery of hypertension in 2012. In 1989, he underwent surgery for "intestinal obstruction", the details of which are unknown. Family history: father died of "gastric cancer".

immune thrombocytopenic purpura (ITP) is a common hemorrhagic disorder characterized by the presence of antiplatelet antibodies in circulating peripheral blood, decreased platelet count and increased risk of bleeding. At present, it has been found that the activation and clearance of macrophages mediated by platelet-specific autoantibody Fc segment produced by B cells is one of the main pathogenesis of ITP^[1]。 B-cell activating factor (BAFF) is a newly discovered member of the tumor necrosis factor (TNF) superfamily, which can promote B lymphocyte survival, maintain germinal center response and T cell activation, and play an important role in autoimmune diseases.

Intraductal breast carcinoma (DCIS) is a breast carcinoma in situ that is confined to the breast ductal system and does not invade the basement membrane and surrounding stroma. Some patients can stay "in situ" for a long time, while others can progress to invasive carcinoma^[1]。 Since the 1980s, with the improvement of mammography technology and the popularization of application, the detection rate of DCIS has been greatly increased^[2,3]。 In the United States, for example, the incidence of DCIS increased from 5.8 per 100,000 person-years in 1975 to 32.5 per 100,000 person-years in 2004, accounting for about 20% of new breast cancer cases each year^[4]。 At present, there is a great controversy about the surgical treatment strategy of intraductal breast carcinoma. It is a difficult problem for surgeons to choose the appropriate surgical method that can not only prevent the development of the natural course of the disease, but also avoid the harm to patients caused by overtreatment. Therefore, this article intends to summarize the controversial issues and research progress in the field of surgical treatment.

Childhood obstructive sleep apnea hypopnea syndrome (OSAHS) refers to a series of pathophysiological changes caused by frequent partial or total upper airway obstruction during sleep, which disturbs children's normal sleep ventilation and sleep structure^[1]。 Its common clinical manifestations include snoring during sleep, mouth breathing, apnea, repeated waking-up, sweating, etc., which can also cause a series of complications, such as inattention, poor memory, mental impairment, low weight or obesity, growth retardation and non-specific behavior difficulties, and pulmonary heart disease or even death in severe cases. Among them, growth retardation has attracted the attention of more and more medical scholars. The research progress on the influence of OSAHS on children's height and its mechanism at home and abroad is summarized as follows.

A 22-year-old male was admitted to Tianjin Haihe Hospital on June 8, 2013 due to "fever, headache for half a month and confusion for 3 days". The patient developed fever and headache half a month ago, with a maximum body temperature of 40 ℃, accompanied by nausea and no vomiting. Anti-infective therapy was given in other hospitals, and intracranial pressure was measured by lumbar puncture up to 500 mmH₂O (1 mmH₂O =9.807×10^–3kPa), considered "viral meningitis", and the effect of antiviral and symptomatic treatment (specificity unknown) is not good. Three days ago, he developed disturbance of consciousness, agitation and coma, and successfully disconnected after tracheotomy and mechanical ventilation for three days. After consultation in our hospital, we considered "tuberculous meningitis" and transferred into the hospital.