Volume 98  ·  Issue 06  ·  2018

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]。

To compare the pulmonary function between adolescent patients with Chiari malformation associated scoliosis (CMS) and adolescent idiopathic scoliosis (AIS).

A retrospective analysis was performed on 52 patients with CMS, and 52 patients with AIS were selected as the control group to match the CMS patients by age, sex, and Cobb angle. Preoperative pulmonary function tests were completed by all the patients, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), maximal mid-expiratory flow (MMEF), and ratio of FEV₁ to FVC. The difference of pulmonary function parameters was analyzed between the two groups; Correlation between pulmonary function and radiographic parameters was analyzed in patients with CMS.

There were no significant differences in terms of sex, age, and the main coronal Cobb angle between the two groups. There were 42(80.7%) and 44(84.6%) of patients with restrictive ventilatory dysfunction (the percentage of predicted FVC<80%) in CMS and AIS group respectively. 18(42.8%) and 10 (22.7%) out of these patients were also with obstructive ventilation dysfunction (FEV₁/FVC<92%) in CMS and AIS group respectively. Types of ventilation dysfunction distributed between the two groups had no significant difference (P>0.05). No significant difference was noted between the two groups in the percentage of predicted VC, FVC, FEV₁ and FEV₁/FVC (P>0.05). The percentage of predicted MMEF in patients with CMS was lower compared to those with AIS[(57.9±13.3)% vs (67.2±23.3)%,P=0.053]. In patients with CMS, the percentage of predicted VC, FVC, FEV₁ and MMEF had significantly negative correlation with the number of vertebrae involved (P<0.01). Main coronal Cobb angle had negative correlation with the percentage of predicted VC, FVC and FEV₁ (P<0.05). The percentage of predicted VC, FVC and FEV₁ had positive correlation with thoracic kyphosis (P<0.05).

There are no significant differences in characteristics of the pulmonary dysfunction between patients with AIS and CMS without obviously neural deficit. Both groups mainly present with restrictive ventilation dysfunction.

To investigate the clinical curative effect of C₁-C₂ pedicle screw fixation for pediatric atlantoaxial dislocation after a long-term follow-up.

From March 2005 to April 2011, a total of 12 male and 9 female patients were included, with age from 3 to 9 years old (mean, 6.1 years old). Among them, 14 cases (67%) had typeⅠinstability atlantoaxial dislocation, 7 cases (33%) had type Ⅱ reducible atlantoaxial dislocation. All 21 pediatric patients with atlantoaxial dislocation underwent posterior pedicle screw fixations. Frankel Grade was used to evaluate function before and after treatment. Furthermore, the information of C₁-C₂ bony fusion, cervical spine alignment, angle of sagittal curvature, and instability of the subaxial spine were collected from all patients preoperatively, immediately postoperatively and during follow-up period.

All 21 patients had regular follow-up with an average duration of 96.4 months (range, 65 to 127 months). All children had good bony fusion within 6 months after treatment. There were 9 patients with lordotic alignment and 12 patients with straight alignment before surgery. After surgery, there were 12 patients with lordotic alignment and 9 patients with straight alignment. At the time of the last follow-up, 17 patients had lordotic alignment and 4 patients had straight alignment. No difference was found between pre- and post-operation (P=0.354). The same result was found between post-operation and last follow-up (P=0.095). Neither kyphotic nor swan-neck deformity was found in any of the 21 patients. The mean angle of sagittal curvature decreased from 31.7°±4.3°preoperatively to 15.5°±2.5°postoperatively (P<0.001). The mean angle of sagittal curvature increased from 15.5°±2.5°postoperatively to 19.1°±2.7°at the final follow-up (P=0.343). No spinal deformities or subaxial instabilities were found. Of the four patients with preoperative neurological defects, Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery.

The results demonstrate that C₁-C₂ pedicle screw fixation could achieve satisfactory clinical effects for the management of pediatric atlantoaxial dislocation with long-term follow-up.

To investigate the relationship between the content of human telomerase reverse transcriptase (hTERT) and its clinical features in serum free DNA in patients with different degree of spinal cord injury.

From December 2013 to December 2016, inpatients of the Central Hospital of Bazhong, Sichuan Province were enrolledand divided into the experimental group, the disease control group and the negative control group. For the experimental group: 46 patients with spinal cord injury were graded according to the criteria of the American Association of Spinal Cord Injury (ASIA), including 12 cases of grade A, 10 cases of grade B, 10 cases of grade C, 7 cases of grade D and 7 cases of grade E; for the disease control group: 15 patients with spinal fractures (without spinal cord injury) at the same period were included; and for the negative control group: 20 healthy adult volunteers aged 18-50 years were selected.Real-time fluorescence quantitative PCR and immunoblotting were performed to detect the content of hTERT in serum free DNA both in patients and healthy controls and to compare the difference between them. The results of the somatosensory evoked potential (SEP) of all patients were compared and analyzed.The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of hTERT content in serum free DNA in patients with spinal cord injury.

Comparison of serum free DNA hTERT content: in the experimental group, the serum free DNA hTERT content of grade A, B, C, D, E was (99.63±8.23), (76.24±4.37), (46.07±5.43), (16.30±0.95) and (15.74±1.12)μg/L, respectively.While it was (15.01±1.39)μg/L in the disease control group and (14.54±1.03)μg/L in the negative control group. The total difference was statistically significant between patients of each group and the control group (F=857.917, P<0.001). Comparison of the protein content of TERT: in the experimental group, the protein content of TERT of grade A, B, C, D, E was 0.736±0.214, 0.641±0.172, 0.606±0.184, 0.411±0.132 and 0.307±0.152, respectively.The protein content of TERT in the disease control group and the negative control group was about 0.312±0.098 and 0.322±0.177, the difference between patients of each group and the control group was statistically significant (F=62.461, P<0.001). Detection results of surface evoked potential (SEP) showed that in the experimental group, level A patients all had conduction block.Two cases of level B patients had conduction block and 8 cases had delayed conduction.Among level C patients, 1 case had conduction block, 9 cases had delayed conduction.Among level D patients and patients from the control group and the negative control group, SEP detection all had no conduction block.

The detection of the hTERT content in serum free DNA in patients with spinal cord injury has a certain guiding significance for the diagnosis of spinal cord injury and the degree of injury.

To investigate the diagnostic value of serum and pleural fluid carcinoembryonic antigen (CEA) for malignant pleural effusion (MPE).

The concentration of CEA in serum and pleural fluid of 286 patients with the diagnosis confirmed by pleural biopsy through medical thoracoscopy were retrospectively analyzed. MPE was confirmed in 171 cases which were divided into two groups (adenocarcinoma group with 121cases and non-adenocarcinoma group with 50 cases) and benign pleural effusion in 115 cases. The optimal cutoff for MPE and MPE caused by adenocarcinoma were determined by using the ROC curve.

The concentration of serum CEA 12.27(3.80, 58.45) μg/L was significantly higher in MPE caused by adenocarcinoma than that of non-adenocarcinoma 1.91(1.08, 4.55) μg/L and benign effusion 1.32(0.86, 2.27) μg/L (both P<0.001), but there was no statistically significant difference between benign and non-adenocarcinoma effusion (P=0.728). The concentration of pleural fluid CEA 160.70(30.48, 1 000.00) μg/L was significantly higher in MPE caused by adenocarcinoma than that of non-adenocarcinoma 1.77(0.51, 11.39) μg/L and benign effusion 1.09(0.60, 1.68) μg/L (both P<0.001), and higher in non-adenocarcinoma effusion than that of benign effusion (P<0.05). The cutoff value of serum and pleural fluid CEA for MPE was 3.10 and 5.83 μg/L, the sensitivity respectively was 67.3% and 74.3%, the specificity respectively was 87.8% and 98.3%, positive predictive value respectively was 89.2% and 98.5%, negative predictive value respectively was 64.3% and 72.0%. The cutoff value of serum and pleural fluid CEA for MPE caused by adenocarcinoma was 3.54 and 7.30 μg/L, the sensitivity respectively was 76.0% and 91.7%, the specificity respectively was 74.0% and 72.0%, positive predictive value respectively was 87.6% and 88.8%, negative predictive value respectively was 56.1% and 78.3%.

The concentration of serum and pleural fluid CEA have diagnostic significance to MPE, especially MPE caused by adenocarcinoma. The diagnostic value of pleural fluid CEA is superior to serum CEA.

To investigate the relations of foramen rotundum structure direction and surrounding structure systematically in order to choose the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia.

A total of 122 patients with V2 of primary trigeminal neuralgia for radiofrequency thermocoagulation were enrolled from August 2012 to May 2017 at the First Hospital of Jiaxing. CT scan images were observed retrospectively, to find the inside and outside of the foramen rotundum. The direction of foramen rotundum were recorded and the best approach of puncturing were analyzed.

The images were divided into four quadrants with the semi - coronal CT scan plane of the lower margin of the zygomatic arch and the outer edge of foramen rotundum for horizontal axis, and the sagittal plane for the vertical axis. In 122 cases, foramen rotundum direction in outer upper quadrant were 77 cases(63.1%), and in outer under quadrant were 22 cases(18.0%), and in inner upper quadrant were 19 cases(15.6%), and in inner under quadrant were 4 cases(3.3%).

The most common foramen rotundum direction is in outer upper quadrant, so the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia is the upper side against zygomatic and the inner side against the wall of maxillary sinus.

To analyze the prevalence and risk factors of diabetic retinopathy (DR) in ophthalmic patients.

A cross-sectional study was performed. Diabetic patients who were admitted to Department of Ophthalmology, Traditional Chinese Medicine Hospital of Muping between October 2012 and June 2013 were included. General information and medical history were obtained from each subject by questionaires. Laboratory and detailed ophthalmic examinations were performed during the study. DR was diagnosed and graded by mydriatic fundus photography. Prevalence of DR was calculated and logistic regression was used to analyze the relationship between DR and various factors.

A total of 676 diabetic patients were included, and 455 of them presented with DR at a morbidity rate of 67.31%. Among DR patients, the number of mild, moderate, severe non-proliferative diabetic retinopathy (NPDR) patients and proliferative diabetic retinopathy (PDR) patients were 211 (46.37%), 167 (36.70%), 57 (12.53%) and 20 (4.40%), respectively. There was no significant difference in the prevalence of DR among different age groups (χ²=6.527, P=0.089). However, there was a significant difference between different disease duration groups (χ²=39.401, P<0.001), as well as between insulin therapy group and non-insulin therapy group (χ²=7.378, P=0.007). The multivariate logistic regression analysis demonstrated the independent risk factors for DR occurrence were hemoglobin A1c (HbA1c) (OR=1.131, 95%CI: 1.022-1.252, P=0.011) and duration of diabetes (OR=1.077, 95%CI: 1.046-1.108, P<0.001).

The prevalence of DR in ophthalmic patients was associated with duration of diabetes, HbA1c, obesity, smoke, nephropaty and insulin therapy. Increased HbA1c level and longer duration of diabetes were independent risk factors for DR in diabetic patients.

To investigate the clinical features and genetic characteristics of patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy.

Clinical data of 3 patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy of Xuanwu Hospital from November 2016 to June 2017 was collected and analyzed.Candidate gene mutations were screened by second generation sequencing.

Among the 3 patients, 1 was male and 2 were females.Seizure onset age was 4 months, 3 years and 5 years after birth respectively. Two patients had family history of epilepsy.They all had prolonged episodes of focal myoclonus. Two patients had mental retardation.Scalp electroencephalograms (EEG) was recorded in all 3 cases and myoclonic seizures were captured.The ictal EEGs were normal in all cases. In one patient, the ictal EEG of generalized seizure showed alpha rhythm originating from left fronto-central region. Brain magnetic resonance imaging (MRI) was normal in 2 patients. Abnormal signal was found bilaterally in cerebellum in 1 patient. The gene screening showed that two patients carried compound heterozygous mutation of TBC1D24 gene and one carried homozygous mutation, all of which were de novo mutations.All the patients were treated with multiple antiepileptic drugs (AEDs) and seizures were uncontrolled in 2 patients. One patient was followed up for 10 months without recurrence.

TBC1D24 gene related early-onset focal myoclonic epilepsy is clinically characterized by early onset, prolonged focal myoclonus which relieved with sleep, mental retardation and poor response to AEDs.The interictal and ictal EEG usually show normal. Genetic analysis can assist in diagnosis and genetic counseling.

To explore the clinical characteristics and prognosis of chronic relapsing inflammatory optic neuropathy (CRION).

A retrospective analysis was conducted. Clinical features, disease course, prognosis and magnetic resonance imaging (MRI) of patients with CRION who were admitted to Department of Neurology between 2014 and 2016 were reviewed and analyzed.

Totally, there were 27 patients (10 males and 17 females), with an age range of 17-59 years. The disease duration was between 40 days and 8 years. There were 2 to 9 CRION episodes. The mean frequency of CRION episodes was 3.30±1.56. The outcome of visual acuity showed that the more episodes frequency was, the worse outcome became. There was 25 abnormal optic nerve signals in MRI. And in 22 cases, the abnormal signals were in intraorbital segment or inner pipe section. The antinuclear antibodies (ANA) titers were elevated in 5 patients. Five cases relapsed during reduction or withdrawal of steroids, but steroids was not added in time. The final outcome of these 5 patients was poor.

CRION was more common in female than male patients. Most patients were companied by pain, and the lesions were more common in the intraorbital segment of optic nerve. The more episode frequency was, the worse prognosis became. If a relapse happened, steroids or other immunosuppressive agents should be used.

To evaluate the clinical application and effect of preseting Double-J ureteric stent in percutaneous nephrolithotripsy.

74 cases of renal calculi treated with PCNL in our hospital during June 2014 to February 2017 were retrospectively analyzed. Of 74 cases, 54 was male, 20 was female. All cases were aged 27 to 78, the mean age was (49.5±12.3) years old. The diameter of the stone was 20 to 59 mm, and the mean diameter was of (29.4±4.3) mm.Our Surgical methods was first putingFr6 double J tube in abnormal ureteral in advance in lithotomy position, then indwellingthree-way Foley catheter and clipping drainage port, perfusingirrigation port with 3 000 ml saline from 60-80 cm height.Perfusingsaline through irrigation port in prone position, we produce artificial hydronephrosis, then indwelling channel Fr20 through B ultrasound guided percutaneous nephrostomy, and removing renal calculi using holmium laser lithotripsy.

All patients were successfully completed percutaneous nephrostomy and indwell Fr20 channel, mean channel set up time (8.0 ±2.0) min, mean operation time (79±46) min, mean decline of hemoglobin (17.0±4.0) g/L, mean serum creatinine increased(3.1±1.1) μmol/L, one-stage stone-free rates 81.1%, complication rate 8.1% (1 case injured pleura and suffered from pneumothorax, 1 case suffered from massive hemorrhage of renal arteriovenous fistula after operation, 4 cases suffered postoperative fever).

Advance in percutaneous nephrolithotripsy indwelling double J tube is a safe and feasible method, which is advantageous to the percutaneous renal puncture and the establishment of channels, and can avoid the blindness of along the line of indwelling double J.

To observe the effect of purple sweet potato anthocyanins on the proliferation of bladder cancer cell line BIU87 and to investigate the molecular mechanisms.

Bladder cancer BIU87 cells were cultured and exposed to anthocyanins at the different concentrations of 100, 200, 400, and 800 μg/ml respectively. The growth inhibition of anthocyanins on BIU87 cells were evaluated by morphometry and cell counting kit-8 (CCK-8) assay, and the cell apoptosis rate was detected by Flow cytometry (FCM).

Morphometry showed that the number of BIU87 cells decreased, the volume shrank, the intercellular space enlarged, the ability of cell adherence weakened, and the cell shape changed when the concentration of anthocyanins increased. CCK-8 assay showed that when 100, 200, 400, 800 μg/ml anthocyanins treated BIU87 cells for 48 h, the absorbance was 24 ± 0.07, 1.15 ± 0.11, 0.90 ± 0.08, 0.56 ± 0.09, respectively. Compared with the control group, anthocyanins-treated groups significantly inhibited the proliferation of BIU87 cells ( P<0.05). FCM test showed that after treatment with different doses of anthocyanins, the apoptosis rate was 7.31%, 11.11%, 25.96%, 36.28%, respectively, and with the concentration of anthocyanins being higher, the apoptosis rate of BIU87 cells was being higher.

Purple sweet potato anthocyanins can inhibit the growth of bladder cancer BIU87 cells through inducing cell apoptosis in a dose-dependent manner.

To evaluate whether baseline interleukin-6 (IL-6), interleukin-10 (IL-10) as well as their ratio was associated with overall mortality risk over 7 years of follow-up in 11 communities of Beijing.

Data from a prospective cohort study conducted between 2005 and 2012 in 11 communities of Beijing was analyzed to examine the above associations. Serum IL-6 and IL-10 were analyzed using enzyme-linked immunosorbent assay (ELISA) kits. Follow-up surveys were conducted in 2007, 2010 and 2012 to collect data about participant′s survival. Cox regression model was used to estimate the impact of IL-6, IL-10 and their ratio on overall mortality risk.

Among 1 539 eligible participants (10 263 total person-years), 77 deaths occurred in 7 years of follow-up. The rates of all-cause death were 4.86, 7.24, and 10.56 per 1 000 person-years (P=0.009) in the first, second, and third tertile of IL-6, respectively. The corresponding age-sex-adjusted hazard ratios (HR) were 1.00, 1.18 (95% CI: 0.64-2.19), and 1.80 (95% CI: 1.01-3.23) and full-adjusted HR were 1.00, 1.17 (95% CI: 0.63-2.19) and 1.87 (95% CI: 1.04-3.36). The corresponding rates of all-cause deaths were not significantly different among three tertiles of IL-10. The age-sex and full-adjusted HR were not significantly different in Cox model. The rates of all-cause death were 4.63, 8.99, and 8.93 per 1 000 person-years (P=0.043) in the first, second, and third tertile of IL-6/IL-10 ratio, respectively. The corresponding age-sex-adjusted HR were 1.00, 1.67 (95% CI: 0.91-3.06), and 1.98 (95% CI: 1.08-3.64) and full-adjusted HR were 1.00, 1.66 (95% CI: 0.90-3.06), and 2.09 (95% CI: 1.13-3.87).

High IL-6 and IL-6/IL-10 ratio may be new risk factors to all-cause death. However, IL-10 is not significantly associated with death.

In order to evaluate disease perception of asthma patients in urban China and provide evidence for further specific patient education.

A multi-center, cross-sectional, questionnaire-based survey was carried out in 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of disease perception [Question 1: the disease nature of asthma; Question 2: medication choice of first-line in chronic asthma; Question 3: the occasion of using short-acting aerosols of receptor agonists; Question 4: perception of asthma treatment goal; Question 5: reason for not using peak flow meter (PFM)] were collected from asthma patients of outpatient department. These results were compared with the same type of survey results from 2007—2008.

Altogether 3 875 asthmatic outpatients were recruited. 69.0% (2 660/3 857) of the patients had right perception on the disease nature of asthma, 60.2% (2 321/3 857) of the patients considered inhaled corticosteroids (ICS)/inhaled corticosteroids plus long-acting beta2-agonists (ICS+ LABA) as daily-used first-line medication for chronic asthma. 85.7% (3 277/3 823) of the patients had right perception on the condition of using short-acting beta2-agonists (SABA). 75.4% (2 761/3 661) of the patients had right perception on asthma treatment goal. Only 10.1% (388/3 837) of the patients used PFM. Of the reasons for not using PFM, 65.2% (2 518/3 860) of the patients chose doctors never introduced. Among the 10 cities, which were also involved in the asthma control survey in 2007—2008, 71.1% (968/1 361) of the patients had right perception on the disease nature of asthma, 61.6% (839/1 362) of the patients considered ICS/ICS+ LABA as daily-used first-line medication for chronic asthma. 88.7% (1 207/1 361) of the patients had right perception on the condition of using SABA. 74.5% (1 013/1 360) of the patients had right perception on asthma treatment goal. 17.9% (244/1 360) of the patients used PFM. Of the reasons for not using PFM, 76.2% (931/1 221) of the patients chose doctors never introduced. Compared to the survey conducted in 2007—2008, the perception on disease nature and medication choice as daily-used first-line medication for chronic asthma significantly improved, the perception on occasion of using SABA and asthma treatment goal was comparable, while the rate of PFM usage showed no significant improvement. In reasons of not using PFM, doctors never introduced ranked the first.

Compared to the similar survey conducted in 2007—2008, the overall status of disease perception of asthma patients has been improved in urban China, while the rate of PFM usage showed no significant improvement. Asthma education on asthma and asthma self-management should be further pushed forward.

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]。