Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis.Methods A total of 141 eligible patients were enrolled in this prospective study.Blood and urine samples were collected at different time points as soon as sepsis was diagnosed.The concentrations of serum creatinine (Scr),urine sTREM-1 and NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,urine sTREM-1 and NGAL were observed in two groups.The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL.Results Among 141 septic patients,44 (31.2％) cases had concomitant AKI.Twenty four hours after sepsis diagnosed,the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6± 15.3) μmol/L,P ＜ 0.05],which met the diagnostic criteria of AKI.In the AKI group,urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9± 14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L,both P ＜ 0.05].And at the following time points,urinary concentrations of sTREM-1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P ＜ 0.05).At 8 h time point,thearea under the curve of urine sTREM-1 was 0.877 (95％CI 0.756-0.914),the sensitivity was 89.1％ and specificity was 82.0％ with a cutoff value of 70 ng/L.At 8 h time point,the area under the curve of urine NGAL was 0.862 (95％ CI 0.703-0.958),the sensitivity was 87.4％ and specificity was 85.5％ with a cutoff value of 90 μg/L.Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr.Therefore,urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.

Background p16INK4a gene plays an important role during the aging and senility.So it was well known to be a leading gene associated with aging.Corneal endothelial cells(CECs) always get trapped in the G1 phase due to the lack of proliferative ability.Whether it is relative with cell senescence is unclear.Objective This study was to investigate the expression ofp16INK4a gene and Bmi1 gene in human CECs from different aged donors ex vivo.Methods The corneal rims,the residual of corneal tissue preserved in DX solution after penetrating keratoplasty,was used in the present study.Parameters were recorded for the donor,including the age,death to preservation interval and preservation to surgery interval.Corneal endothelium survival rate and endothelial cell density were evaluated by trypan blue-alizarin red dying immediately after penetrating keratoplasty.Routine haematoxylin and eosin staining was also performed to proof the normal structure of the cornea.Sections of corneas from different aged donors were classified into ＜30 years group,30-50 years group and ＞50 years group and were immunostained to assess the expressions of p16INK4aprotein,Bmi1 protein and Ki67 protein in CECs.Total RNA was extracted from independent corneal sample for the evaluation of p16INK4a mRNA,Bmi1 mRNA and Ki67 mRNA expression in CECs by quantitative real-time PCR(qRT-PCR).Results The endothelial cell density of each group was (3069 ±172),(2748±64),(2444 ±178)cells/mm2,respectively.Haematoxylin and eosin staining showed the normal structure of corneal epithelium,stroma and endothelium.qRT-PCR examination revealed an age-related increase in p16INK4a mRNA expression in the CECs(F =5.703,P =0.014) and a decrease in Bmi1 mRNA and Ki67 mRNA expression (F =3.950,P =0.042;F=548.500,P =0.000).The further comparison verified a significant elevation in the expression of p16INK4a mRNA in the CECs of the ＞50 years group compared with ＜30 years group and significant decline in Bmil mRNA and Ki67 mRNA the expression (P =0.006,0.013,0.000).Immunohistochemistry in situ confirmed the expression and nuclear localization of p16INK4a protein in CECs,and the expressing intensities of Bmi1 and Ki67 proteins in the elder donors were weaker than those of the younger donors.The immunofluorescence exhibited that the expressing intensity of p16INK4a protein in CECs of 58 years old donor was higher than that of 23 years old donor,showing a consistent result with that of qRT-PCR.Conclusions Expression of p16INK4a gene increases and that of Bmi1 gene decreases upon age.These results suggest that p16INK4a gene is associated with senescence of human CECs.

Objective:To study changes of serum concentrations of high mobility group protein B1 (HMGB1),endo- thelin (ET )-1 and macrophage migration inhibitory factor (MIF ) in patients with type 2 diabetes mellitus (T2DM)complicated coronary heart disease (CHD)and explore their correlations with inflammatory factors.Meth-ods:The 120 patients with T2DM+ CHD treated in our hospital from May 2013 to Sep 2014 were enrolled in obser-vation group,including 30 cases with SAP,30 cases with UAP,30 cases with NSTEMI and 30 cases with STEMI. Another 30 T2DM cases without cardiovascular diseases during the same period were enrolled as pure DM group.En- zyme linked immunosorbent assay was used to measure concentrations of HMGB1,ET-1,MIF,CRP,TNF-α,IL-6, IL-8,IL-17 and IL-23,and they were compared among above groups.Results:Compared with pure DM group, there were significant rise in serum concentrations of HMGB1 [(3.49±0.52)μg/L vs.(9.18±1.02)μg/L],ET- 1 [(104.54±12.56)ng/L vs.(256.56±34.16)ng/L],MIF [(87.78±10.52)ng/L vs.(178.32±21.34)ng/L], CRP [(6.28±0.84)mg/L vs.(16.52±2.15)mg/L],TNF-α[(8.54±1.09)ng/L vs.(21.91±2.76)ng/L],IL- 6 [(2.25±0.34)ng/L vs.(6.34±0.82)ng/L],IL-8 [(7.23±0.94)ng/L vs.(15.41±1.97)ng/L],IL-17 [(65.34±8.32)ng/L vs.(141.62±20.18)ng/L]and IL-23 [(125.22±14.23)ng/L vs.(321.12±41.54)ng/L] in observation group,P<0.05 or <0.01. The serum concentrations of HMGB1,ET-1 and MIF were SAP group

6 months was 42.3 months, longer than 17.5 months for patients with PFI ≤ 6 months, no statistical significance was found ( P =0.1418). Multivariate analysis strongly suggested that PFI and the courses of second line chemotherapy were independent prognostic factors of survival after secondary treatment for epithelial ovarian cancer. For those patients with PFI ≤ 6 months, the smaller the size of residual lesion ( P =0.0003) and the more the cycle of effective second line chemotherapy ( P =0.0004), the longer the survival after the secondary cytoreduction. Conclusions:The results suggested that successful secondary cytoreductive surgery combined with multicycles second line chemotherapy may be an effective way to lengthen the survival on retreatment for patients with platinum resistant and recurrent epithelial ovarian cancer.

Objective To analyze the application effect and safety of streamlined liner of the pharynx airway (SLIPA) anesthesia in painless fiberoptic bronchoscopy (FB).Methods Two hundred and eighty-two patients who undorwent FB examination in Kaifeng Second People's Hospital from January 2015 to January 2017 were selected and divided into observation group and control group,with 141 patients in each group.The patients in observation group were given SLIPA assisted anesthesia;the patients in control group were given endoscopic mask assisted anesthesia.The oxygen saturation (SpO2),systolic blood pressure (SBP),diastolic pressure (DBP) and heart rate (HR) of patients in the two groups were monitored.The changes of SBP,DBP and HR,the incidence of adverse reactions and the satisfaction of patient to the anesthesia were compared between the two groups.Results The fluctuation of HR,SBP and DBP of patients in the observation group was (3.52 ± 2.92) times · min-1,(7.04 ±5.30) mmHg(1 mmHg =0.133 kPa),(1.52 ± 1.63) mmHg respectively and in the control group was (5.52 ± 1.89) times · min-1,(30.12 ± 8.88) mmHg,(4.06 ± 5.78) mmHg respectively;the fluctuations of HR,SBP and DBP of patients in the observation group were significantly less than those in the control group(P ＜ 0.05).In the observation group,12 patients with cough,8 patients with abdominal distension,6 patients with pharyngeal pain,2 patients with SpO2 ≤90％,4 patients with SpO2 ＜ 85％;in the control group,57 patients with cough,32 patients with abdominal distension,47 patients with pharyngeal pain,28 patients with SpO2 ≤90％,19 patients with SpO2 ＜ 85％.The incidence of adverse reactions of patients in the observation group was significantly lower than that in the control group (x2 =27.10,61.82,41.59,72.46,87.75;P ＜0.05).The anesthesia satisfaction of patients in the observation group(97.87％) was significantly higher than that in the control group(82.98％) (x2 =29.97,P ＜ 0.05).Conclusion SLIPA assisted anesthesia has good clinical effect and safety in patients with painless FB.

Objective: To analyze the correlation among serum adiponectin (APN), heme oxygenase-1 (HO-1) concentrations and severity of coronary lesion in patients with acute coronary syndrome (ACS). Methods: A total of 78 ACS patients, who hospitalized and received therapy in our hospital from Oct 2013 to Oct 2014, were enrolled as ACS group. According to severity of coronary lesion, they were further divided into single vessel coronary disease group (single vessel group, n=15), double-vessel coronary disease group (double-vessel group, n=37) and multi-vessel coronary disease group(multi-vessel group, n=26). Another 72 subjects without coronary heart disease (CHD), who received physical examination in our hospital during the same period, were selected as non-CHD control group. Serum concentrations of APN and HO-1 were measured in all groups. The correlation among serum APN, HO-1 concentrations and severity of coronary lesion were analyzed. Results: Compared with non-CHD control group, there were significant reductions in serum concentrations of APN [(15.27±2.31) mg/L vs. (5.73±0.88) mg/L] and HO-1 [(55.09±8.63) μg/L vs. (23.17±3.09) μg/L] in ACS group, P<0.01 both. Compared with single vessel group, there were significant reductions in serum concentrations of APN[(9.72±1.13) mg/L vs. (7.05±0.93) mg/L vs. (4.23±0.52) mg/L] and HO-1 [(38.16±7.52) μg/L vs. (28.17±5.31) μg/L vs. (20.32±3.28) μg/L] in double-vessel group and multi-vessel group, and those of multi-vessel group were significantly lower than those of double-vessel group, P<0.05 or <0.01. Linear regression analysis indicated that serum concentrations of APN and HO-1 were significant inversely correlated with severity of coronary lesion (r=-2.869, -2.742, P<0.05 both). Conclusion: Serum concentrations of APN and HO-1 significantly reduce in ACS patients, and their levels are significant inversely correlated with severity of coronary lesion, so they are helpful to judging patient’s condition and guiding treatment.

Objective:To analyze the correlation among serum adiponectin (APN) ,heme oxygenase‐1 (HO‐1) con‐centrations and severity of coronary lesion in patients with acute coronary syndrome (ACS) .Methods :A total of 78 ACS patients ,who hospitalized and received therapy in our hospital from Oct 2013 to Oct 2014 ,were enrolled as ACS group .According to severity of coronary lesion ,they were further divided into single vessel coronary disease group (single vessel group ,n=15) ,double‐vessel coronary disease group (double‐vessel group ,n=37) and multi‐vessel coronary disease group (multi‐vessel group , n = 26 ) . Another 72 subjects without coronary heart disease (CHD) ,who received physical examination in our hospital during the same period ,were selected as non‐CHD con‐trol group .Serum concentrations of APN and HO‐1 were measured in all groups . The correlation among serum APN ,HO‐1 concentrations and severity of coronary lesion were analyzed .Results:Compared with non‐CHD con‐trol group ,there were significant reductions in serum concentrations of APN [ (15.27 ± 2.31) mg/L vs .(5.73 ± 0.88) mg/L] and HO‐1 [ (55.09 ± 8.63)μg/L vs .(23.17 ± 3.09)μg/L] in ACS group ,P<0.01 both .Compared with single vessel group ,there were significant reductions in serum concentrations of APN [(9.72 ± 1.13) mg/L vs . (7.05 ± 0.93) mg/L vs .(4.23 ± 0.52) mg/L] and HO‐1 [(38.16 ± 7.52)μg/L vs .(28.17 ± 5.31)μg/L vs .(20.32 ± 3.28)μg/L] in double‐vessel group and multi‐vessel group ,and those of multi‐vessel group were significantly low‐er than those of double‐vessel group ,P<0.05 or <0.01 .Linear regression analysis indicated that serum concentra‐tions of APN and HO‐1 were significant inversely correlated with severity of coronary lesion (B= -2.869 , -2.742 , P<0.05 ,<0.01 respectively) .Conclusion:Serum concentrations of APN and HO‐1 significantly reduce in ACS patients ,and their levels are significant inversely correlated with severity of coronary lesion ,so they are help‐ful to judging patient's condition and guiding treatment .

Purpose:To evaluate the significance of abdominal residue after primary cytoreductive su rgery for stage Ⅲ ovarian cancer.Methods:From Nov 1990 to Nov 1996, 57 patients with stage Ⅲ ovarian cancer who underwen t primary cytoreduction in our hospital and their residual disease were analyzed , with mean age of 51.9 (23～74). 20 patients achieved optimal cytoreduction (th e largest residual tumor ≤ 1cm). 9 patients had no gross residual tumor after s urgery, 37 cases had residual disease both in the abdomen and pelvis. Abdominal residual disease was found in 7 cases and pelvic residual disease in 4 cases. 30 cases were given chemotherapy before surgery. After primary surgery, 36 patient s received a mean of 3 courses of intraperitoneal chemotherapy and 46 patients were treated with a mean of 4 cycles of platinum-based intravenous chemotherapy . Complete remission were achieved in 32 cases (56.1%).Results:With a mean follow-up of 29.1 months (0.3～109.1months), 1-5 year survival rat es were 79.82%, 57.59%, 49.06%, 39.93%, 23.41%, respectively. Univariate analysi s indicated stage (P=0.0283), size of residual disease (P=0.0041), resid ue in the abdomen (P=0.0362), type of surgery (P=0.0337) and intraperito neal chemotherapy after surgery (P=0.0469) influenced survival. Multivariate analysis suggested that size of residual disease (P=0.0025), intraperiton eal chemotherapy (P=0.0323) and intravenous chemotherapy (P=0.0297)aft er surgery were independent prognostic factors of survival. Those patients who h ad no macroscopic residual lesion in the abdomen after cytoreducion had a better survival, with estimated median survival of 58.0 months vs 22.7 months for pati ents with abdominal residue (P=0.0362), with 3-year, 5-year survival rate of 83.64% vs 37.60% and 29.57% vs 21.05%, respectively. Residual disease in the pelvis did not affect the survival (P=0.2782). For patients with abdominal r esidue after surgery, optimal abdominal cytoreduction predicted increased surviv al (P=0.0319), while optimal pelvic cytoreduction predicted increased progre ss-free survival (P=0.0104). Stage(P=0.041), chemotherapy before surg ery(P=0.009)and pathologic classification(P=0.042)were determinants for abdominal residue after cytoreduction.Conclusions:The size of residual disease and abdominal residue after cytoreduction affected the progn osis for stage Ⅲ ovarian cancer. Patients with abdominal residue suffered a pes simistic outcome. Residual lesions in the abdomen influenced the patients' surv ival, while pelvic residue affected progress-free survival.

Objective To evaluate the method and result of pollution sources clearance in the reservoir area. Methods Calculated the areas of pollution sources such as pigsties, livestock barns, lavatories, holes for sewage and tombs in the reservoir area of the Yingnahe River, Dalian City after cleared them up in 2002. Collected the soil samples which were not disinfected after clearing up, and the samples disinfected with quicklime or bleaching powder. Evaluation was done according to the GB7959-1987 Standard for the Non-hazardous Treatment of Night Soil. Results The area of pollution source of each livestock barn, pigsty, lavatory, birdhouse, hole for sewage, tomb was 77.4, 74.2, 31.7, 32.1, 36.3 and 158.5 m2 respectively. The qualification rates of the E.coli and the egg of worm counts in the soil samples collected from pollution sources of pigsties disinfected and not disinfected after clearance were 85.94%, 90.31% and 96.88%, 99.38% respectively, the differences were significant. The qualification rates of the E.coli(95.78%)and the egg of worm(99.85%)in the disinfected soil samples collected from the pollution sources in the reservoir area after clearance were close with that of the control collected from the hillside wasteland in the reservoir area. Conclusion Clearance combined with disinfection can make the clearance of pollution sources in the reservoir area meet the request of related standard.