Acute kidney injury(AKI) is a clinical critical syndrome caused by a variety reason,sepsis is the leading cause and independently associated with mortality in critical patients.Fluid resuscitation is one of the most important treatment of spesis and AKI.Fluid overload has been shown to be associated with worse outcomes in critically ill patients.Different liquid treatment should be adopted in different stages.To carry out dynamic,noninvasive hemodynamic monitoring is the best way to critical patients with AKI liquid management.

Objective To study the value of plasma level of matrix metalloproteinase-9 (MMP-9) for the early diagno-sis of Kawasaki disease. Methods The difference in MMP-9 level was studied by retrospective nested case-control method between children with early Kawasaki disease, Henoch-Sch?nlein purpura (HSP) or respiratory infection, and healthy control children. The associations of MMP-9 with serum procalcitonin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also analyzed. The cutoff-value, sensitivity and speciifcity of MMP-9, ESR and CRP in diagnosis of Kawasaki disease were studied by ROC curve. The areas under ROC curves were compared among different diagnostic markers to deter-mine their signiifcances in diagnosis of Kawasaki disease. Results The plasma level of MMP-9 was increased in early phase of Kawasaki disease, and higher than that in children with HSP or respiratory infections and in healthy controls (P<0.05). If MMP-9, ESR and CRP cutoff value were set to be 90.23 ng/ml, 56.5 mm/h and 27.55 mg/L, the sensitivity, speciifcity and area under ROC curve was 83.3%, 86.4%and 0.904, 95.8%, 66.1%and 0.807, 83.3%, 74.6%and 0.789 respectively. The diagnostic performance of MMP-9 for Kawasaki disease was better than that of ESR and CRP. Conclusions The plasma level of MMP-9 is increased in the early stage of Kawasaki disease. The sensitivity and speciifcity of MMP-9 in diagnosis of Kawasaki disease are highest if cutoff value is set to be 90.23 ng/ml.

Objective To report the clinical manifestation and gene mutation of congenital insensitivity to pain with anhidrosis (CIPA) in two patients from one family. Methods The data of clinical manifestation, laboratory examination, and family history of two patients were collected. The peripheral blood of patients and their parents were collected. Neurotrophic tyrosine kinase receptor type 1 (NTRK 1 ) gene was detected directly by Sanger method, the pathogenicity of the mutation in the gene was analyzed by bioinformatics. Results Both of patients were female and mainly suffered with reduplicated non-infectious fever, anhidrosis, insensitive to pain, and mental retardation. The proband had fracture many times after minor injury. The ninth exon of NTRK 1 genes in the proband and her younger sister were found to have heterozygous mutations, c. 851-33 T>A, as previously reported. Meanwhile, there was also found a new mutation, c. 1711 G>A (p.G 571 S), in thirteenth exon of NTRK 1 genes in these two patients. It was predicted to be a harmful mutation by bioinformatics and the mutation site is conservative. Their father and mother were found carrying the c. 851-33 T>A and c. 1711 G>A mutations respectively. Conclusion Both patients had typical clinical manifestations. And the newly discovered p.G 571 S mutation expands the mutation spectrum of NTRK 1 gene.

Enteritis ; diagnosis ; Eosinophilia ; diagnosis ; Gastritis ; diagnosis ; Humans ; Pancreatitis ; diagnosis

Objective To study the influence of Apo E gene knockout on the lymphocytes . Methods Cells from the peripheral blood, spleen and bone marrow of Apo E knockout and wildtype mice were stained with kinds of antibodies , and analyzed by flow cytometry .Results Compared with wildtype mice , significant differences were found in B and T lymphoctes in the peripheral blood and spleen , but there was no significant difference in pre B cells , T lymphocytes in the thymus and long term hematopoietic stem cell in the Apo E knockout mice .Conclusion Numbers of B lymphocytes decreased in the peripheral blood and spleen , but there was no significant difference in B , T lymphocytes development , and numbers of long term hematopoietic stem cell in Apo E gene knockout mice .

Objective To investigate the therapeutic efficacy of castration with 125I brachtherapy in middle and late stage prostate cancer. Methods Sixty-six patients with prostate cancer from 2004 to 2009 were analyzed, 40 were at clinical stage C and 26 were at clinical stage D, 42 had a pathologic grade G2 and 24 had a pathologic grade G3. The first endocrinal therapy used was total androgen blockade (chemical castration and anti-androgen drugs). The therapeutic time was three months before bilateral orchidectomy and brachtherapy. A 3D radiotherapy planning system was used for brachtherapy with transrectal ultrasound-guided radioactive 125I seed uniform implantation. Follow-up endocrinal therapy was decided according to a monthly check of serum PSA (prostate specific antigen) levels. After six months, serum PSA, IPSS and volume of the prostate before and after treatment were compared. Results The operations were completed successfully in all cases. The mean number of 125I seeds implanted was 55. The mean follow-up was 10 to 62 months, with an average of 49 months. Serum PSA, IPSS and the volume of the prostate was reduced significantly six months after operation (P<0.05). Conclusions Castration with 125I brachtherapy is an effective approach in combination therapy for treating middle and late stage prostate cancer.

Objective To study the effect of intra-pulmonary arterial anti-tumor necrosis factor-α antibody(TNF-α Ab) on ultra-structure of lung after cardiopulmonary bypass (CPB).Methods Forty New Zealand rabbits were selected and randomly divided into four groups:group Ⅰ-Ⅲ underwent CPB; group Ⅳ only received open chest operation.In the group Ⅱ,rabbit TNF-α Ab(27 ng/kg) was dropped into the pulmonary artery when the aorta was clamped and CPB continued 30 minute.Pulmonary arterial perfusion was given to the group I instead.Blood TNF-α and neutrophils count from right and left atrium and oxygenation index in the four groups were determined perioperatively.Lung water content,TNF-αmessenger RNA,Bcl-2 protein,Bax protein,Bcl-2/Bax,apoptosis index and pathomorphological change were measured in the lung tissues.Results TNF-α Ab can restrain leukocyte accumulation and reduce releasing of TNF-α in the lung and improve oxygenation index.Moreover,TNF-α Ab can reduce the expression of Bax on alveolar epithelial cells and alleviate the decreasing of the expression of Bcl-2.It can also reduce the occurrence of apoptosis and attenuate pathomorphological changes in the lung tissue.Conclusion Intra-pulmonary arterial antitumor necrosis factor-α antibody markedly lessens the injury of inflammatory reaction and ultra-structure of lung after CPB via Bcl-2/Bax pathway.

Objective To explore the clinical-pathological characteristics, treatment and prognosis of eosinophilic gastro-enteritis in children. Methods The data of clinical manifestation, laboratory examination, endoscopy, biopsy, management and prognosis from 2 pediatric patients with eosinophilic gastroenteritis were retrospectively analyzed. Related articles were reviewed. Results The age of two patients was 13 and 14 years old. Case 1 was male and had an onset with acute pancreatitis. Case 2 was female with a history of food allergy and had an onset with unexplained ascites. Both patients presented with signiifcantly increased peripheral eosinophil count (45.9%-64.8%) and serum IgE (246-393 IU/ml). Bone marrow cytology showed increased proportion of eosinophils in both patients. Gastroscopy was performed in case 1 while gastroscopy and colonoscopy endoscopy were performed in Case 2 and the results indicated eosinophilic inifltration in duodenum. Duodenal mucosa biopsy showed eosinophilic inifltration in case 1 while gastrointestinal pathology biopsy showed multiple mucosal eosinophil inifltration in case 2. After the therapy of food avoidance, steroid and anti-allergic drugs, both patients had complete remission 1 week later. Meanwhile the peripheral eosinophil count was decreased to normal. Case 1 was followed up for 24 months, and case 2 was followed up for 2 months. Both patients showed no evidence of relapse. Conclusions The clinical manifestation and endoscopic examination of eosinophilic gastroenteritis in children are protean and lack of speciifcity. Unexplained gastrointestinal symptoms accompanied with eosinophilia may suggest the possibility of eosinophilic gastroenteritis. Eosinophilic inifltration in ascites and gastrointestinal mucosa strongly indicate the di-agnosis of eosinophilic gastroenteritis. After exclusion of other possible diseases, the deifnite diagnosis can be made.

Objective: To investigate the expression of caspase1 mRNA in hippocampus of(developing) rats following recurrent seizures and the effects of tetramethylpyrazine on it.Methods: One(hundred) and(sixty)two postnatal SpragueDawley rats of 20day old were randomly divided into three groups: the control group,the seizure group and the tetramethylpyrazine treated group.Seizure model of rats were induced by(inhalant) flurothyl daily in 6 consecutive days.Brain tissue was sampled at 6 hours,1 day,(3 days) and 7 days in each group after last seizure,and the expression of caspase1 mRNA in the hippocampus was(detected) by(reverse) transcriptionpolymerase chain reaction(RTPCR).At the same time,the water content was(detected) and the pathological changes in the hippocampus of rats were observed after recurrent seizures and the brain injury was evaluated by using a semiquantitative neuropathological scoring system.Results: In(tetramethylpyrazine) treated group,the levels of caspase1 mRNA in the hippocampus,water content of brain tissues and neuropathological score at different time points were obviously lower than those in seizure group(except water content of brain tissues at 7 days,all P

Objective To investigate the incidence and influencing factors of aldosterone escape in patients with non-diabetic nephropathy by RASI-therapy. Methods A total of 104 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB in a mean follow-up period of 12 months. Aldosterone escape was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment, while the influencing factors of aldosterone escape in patients with non-diabetic nephropathy was also analyzed after therapy with RASI . Results In 12 months, the incidence of aldosterone escape was significantly higher than that in 6 months (26.92% vs. 14.42%, P = 0.007). After 12-month treatment, the difference was statistically significant in incidence of aldosterone escape among different stages of CKD (P = 0.027). Compared with 6-month incidence of aldosterone escape in the losartan group, 12-month incidence increased evidently (P = 0.020). The Ald level was positively correlated with urinary protein excretion and the Scr level (r = 0.431, P = 0.003 and r = 0.336, P = 0.009, respectively), and negetively correlated with levels of the eGFR (r = -0.275, P = 0.006). Univariate Logistic regression demonstrated that risk factors of aldosterone escape included pre-treatment values of the urinary protein excretion (OR = 3.671, P = 0.028) and the eGFR (OR = 0.972, P = 0.019). Multivariate Logistic model revealed pre-treatment values of the eGFR was positively associated with aldosterone escape (OR = 0.970, P = 0.012). Conclusion The incidence of the aldosterone escape increases along with the time of treatment. Renal function has correlated with aldosterone escape and pre-treatment value of the eGFR is an independent risk factor of aldosterone escape.