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Objective:To investigate the causes, diagnosis, treatment and prognosis of children with spinal cord injury without radiologic abnormality caused by non-severe violence, and to raise the awareness of spinal cord injury in children.Methods:Retrospective analysis was performed on the age of onset, injury mechanism, main clinical symptoms and occurrence time, treatment process and recovery of children with spinal cord injury without radiologic abnormality caused by non-severe violence. The children were admitted to our hospital from August 2015 to September 2020. Abnormal findings in spinal cord MRI in acute stage were analyzed, and long-term prognosis was followed up by telephone. The degree of spinal cord injury was determined according to the criteria established by the American Spinal Cord Injury Association.Results:Of six patients, three boys and three girls, aged from 16 months to 8 years old.Injury mechanism: fall on the bed, a sudden fall in standing position, fall while jumping in sports.All of the symptoms appeared immediately after trauma, such as limb weakness, pain, unable to walk, urination disorders.Treatment process: spinal immobilization, methylprednisolone pulse therapy[20 mg/(kg·d)], alleviat edema and protect the nerve system, necessary symptomatic treatment including urethral catheterization, the use of antibiotics, timely rehabilitation treatment.No fracture or dislocation was found in all six patients by spinal cord radiometric examination, and MRI of spinal cord indicated abnormal signals of thoracic cord or below. The recovery sequence of spinal cord function: urination function recovery, pain from lower limbs relief, lower limbs weakness improvement.By the time of follow-up by telephone, the course of disease was 1 to 5 years. Urine fecal incontinence was found in one patient, and his muscle strength of both lower extremities belong to grade Ⅰ, atrophic changes were found in spinal cord MRI.The remaining five patients were able to walk independently, complained of leg pain during long distance walking, mild varus or valgus, and no obvious abnormality in spinal cord MRI.Conclusion:In daily activities, except bend down in dancing, falling on the sacral tail is easy to cause spinal cord injury without fracture and dislocation in children. The damaged spinal cord function often cannot recover thoroughly, and even cannot recover. It is advisable to identify early, formulate comprehensive treatment measures in time, strive to improve the prognosis.
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Objective:To explore the clinical characteristics of pneumocystis carinii pneumonia (PCP) after kidney transplantation.Methods:From January 2020 to January 2022, clinical data were retrospectively reviewed for 13 renal transplant recipients with pneumocystis pneumonia diagnosed by metagenomics next generation sequencing (mNGS). There were 3 females and 10 males with an age range of (46±10) years.The median time of postoperative onset was 10(2-21) months; The major clinical manifestations included fever ( n=11), cough ( n=7), expectoration ( n=6) and dyspnea ( n=11). Paired t-test was employed for analyzing the laboratory results at admission and discharge. Results:The diagnosis was confirmed by the detection of NGS in alveolar lavage fluid or venous blood.The levels of G test, LDH test, total T lymphocyte absolute count (CD3+ Abs), inhibitory/cytotoxic T lymphocyte count (CD3+ CD8+ Abs) and auxiliary/induced T lymphocyte absolute count (CD3+ CD4+ Abs) were (543.27±440.49) pg/ml, (529.98±222.43)U/L and (191.92±119.42)/μl, (87.33±50.59)/μl and (106.92±87.42)/μl at admission and (69.58±50.21) pg/ml, (285.38±46.62 U/L), (888.58±672.99)/μl, (336.83±305.21)/μl and (520.08±388.76)/μl at discharge.The differences were statistically significant ( P<0.001, P=0.002, 0.006, 0.017, 0.005). All of them received compound sulfamethoxazole and caspofungin.Except for one death due to septic shock after 21-day treatment, 12 cases were cured. Conclusions:mNGS test is one of the important tool for an early diagnosis of PCP.Combined use of compound sulfamethoxazole and caspofungin is an effective anti-infective regimen.And immune function monitoring is vital for adjusting antibiotic and immunosuppressive regimens.
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Objective:To evaluate the efficacy and safety of continuous infusion of low-dose intravenous (Ⅳ) heparin during perioperative period of simultaneous pancreas-kidney (SPK) transplantation for donation after citizen death (DCD) donor to prevent pancreatic thrombosis post-transplantation.Methods:From January 2015 to August 2019, 46 DCD donors undergoing SPK were divided into retrospective cohort groups 1 ( n=27) and 2 ( n=19). Group 1 received aspirin enteric-coated tablets only at Day 1 post-SPK. In Group 2, 5-7 days of continuous infusion of heparin 260 IU per hour at Day 1 post-SPK was followed by a daily intake of aspirin enteric-coated tablets of 100 mg. Incidence of thrombus, recovery of graft function and adverse reactions of anticoagulant therapy were observed. Results:Thrombosis occurred in (5.3%, 1/19 vs 14.8%, 4/27) in heparin and non-heparin groups. Thrombosis and graft loss were significantly lower in heparin group than those in non-heparin group ( P<0.05). Conclusions:Continuous infusion of low-dose heparin vein is effective and safe in preventing thrombosis after SPK transplantation.
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Objective@#To investigate the clinical characteristics, diagnosis, treatment and prognosis of discordant lymphoma.@*Methods@#The clinical data of one patient with discordant lymphoma at the PLA Strategic Support Force Characteristic Medical Center were retrospectively analyzed, and the related literatures were reviewed.@*Results@#The patient was treated for thrombocytopenia and the examination showed splenomegaly. After hormone treatment, the platelet rebounded and thrombocytopenia occurred during hormone reduction. Splenectomy was performed. Postoperative pathological diagnosis of splenic marginal lymphoma was made and observed. Axillary lymph node enlargement occurred nine months later. Pathological diagnosis of diffuse large B-cell lymphoma was made by using lymph node biopsy, and the disease condition was alleviated after immunotherapy combined with chemotherapy.@*Conclusions@#Discordant lymphoma is rare and shows no special clinical manifestations. Its diagnosis should rely on pathological examination. Immunotherapy combined with chemotherapy may be more effective.
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Objective To evaluate the effectiveness of salvage liver transplantation ( SLT) versus repeat hepatectomy (RH) in post-hepatectomy recurrent hepatocellular carcinoma. Methods Data from 1 January 1990 to 31 July 2018 were retrieved from the Cochrane library, PubMed, EMbase, Wan Fang Data, CBM, CNKI, VIP and other databases. The collected publications were all on case-control studies comparing SLT with RH for post-hepatectomy recurrent hepatocellular carcinoma. The literatures’ quality and the data of each study were evaluated and analyzed using RevMan. Relative risk (RR) and 95% confidence interval (CI) were used. Results Five articles which included 525 patients were enrolled. There were no signifi-cant differences between SLT and RH on the 1-, 3-and 5-year overall survival (P＞0. 05 for all). Howev-er, for the 1-year (RR=2. 86, 95% CI: 1. 37～5. 97, P＜0. 05), 3-year (RR=2. 57, 95% CI: 0. 99～6. 70, P=0. 05), and 5-year disease-free survivals (RR=4. 79, 95% CI: 1. 88～12. 25, P＜0. 05), PLT was significantly better than RH. Conclusion The effectiveness of SLT was superior to RH in the treatment of post-heptectomy recurrent hepatocellular carcinoma. However, considering the similar overall survival rates, RH is still an important treatment option for post-hepatectomy recurrent hepatocellular carcinoma because of liver donor shortage.
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Objective To strengthen the understanding of granulocytic sarcomas(GS)by investigating the clinical characteristics of GS of spine. Methods The clinical data of 2 GS patients were retrospectively analyzed, and the related literature was reviewed. Results Because of the double lower limbs numbness, the 2 GS patients came to orthopedics department of the 306th Hospital of PLA. Magnetic resonance imaging (MRI) of the 2 patients showed an epidural mass located at the 9th-11th and 2nd-4th thoracic levels. Their histopathological examination and immunohistochemistry revealed GS.For example 1,she was diagnosed with acute promyelocytic leukemia(APL)and has been morphologic complete commission(CR) from 1995 to 2015. Chemotherapy and all-trans retinoic acid (ATRA) were performed after extramedullary relapse in thoracic spine,breast,ovary,sternum bone and lymph nodes.So far,the patient is still in follow-up.For example 2,he was diagnosed as isolated GS by morphology, immune phenotype, chromosome and gene examinations. Because he refused chemotherapy, radiotherapy was performed after surgical intervention. So far, he is loss of follow-up. Conclusions Spinal epidural of GS is rare. Surgery can reduce or remove nerve compression symptoms, and help clear diagnosis. The current recommended treatment regimen in patients presenting with isolated GS or GS presenting concomitantly with AML is conventional AML-type chemotherapeutic protocols. The differences in prognosis of GS patients may be partially attributed to different characteristics of patient.
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Objective To evaluate the efficacy of sirolimus (SRL) after liver transplantation for hepatocellular carcinoma (HCC).Methods The information up to January 2018 was retrieved from Cochrane library,Pubmed,EMbase,CBM,CNKI,VIP.Collected publications were all about casecontrol study of SRL versus calcineurin inhibitors (CNIs) after liver transplantation for HCC.After evaluating the literatures' quality and extracting the data,RevMan 5.3 was used to analyze the data of each study.Results A total of 13 articles including 4181 patients were enrolled.There was no significant difference between SRL and CNIs in 3 and 5 year diseasefree survival (RR=1.13,95％CI:0.97-1.31,P=0.11;RR=1.07,95%CI:0.92-1.24,P=0.37),however,the 1-,3-and 5-year overall survival rate and 1-year disease-free survival rate in SRL were significantly higher than CNIs (RR=1.09,95％CI.:1.03-1.15,P=0.005;RR=1.08,95％CI:1.02-1.14,P =0.006;RR =1.11,95％CI:1.00-1.23,P =0.05;RR=1.14,95％CI:1.05-1.24,P =0.001).Conclusion There was no significant difference between SRL and CNIs in 3-and 5-year disease-free survival,but the 1-,3-and 5-year overall rate and 1-year disease-free survival rate in SRL was significantly higher than in CNIs.