The risk of death and chronic kidney disease will increase if severe patient development of acute kidney injury (AKI).International organizations in multiple disciplines of experts dedicated to the study early recognition and diagnosis AKI.And 3 new classification systems were recently developed in order to improve the ability of early diagnosing AKI.Sepsis is a common cause of pediatric hospital.It is also the most common cause of severe ill children developed AKI.Development of AKI during sepsis increases patient chronic kidney disease morbidity,predicts higher mortality.So it is crucial to early identify AKI to avoid delay in initiating renal protective and appropriate therapeutic measures.

Objective To explore change and significance of serum and urinary transforming growth factor-? 1(TGF-? 1)in the patients with primary chronic glomerulonephropathy (PCG). Methods 65 patients with PCG were divided into four groups according to the degree of renal function damage: normal renal function,renal compensatory,renal decompensatory and renal function failure groups. Levels of serum and urinary TGF-? 1 were determined with ELISA, and the levels of urinary protein and renal function were examined as well. Results Levels of serum and urinary TGF-? 1 in patients with PCG were singificantly higher than those in control, and the levels of serum and urinary TGF-? 1 among four groups were significantly different. The TGF-? 1 level of urinary was associated with the degree of renal function damage(r=0 28,P

Objective To identify the diffusion alterations of deep gray matter(GM) and white matter (WM) among Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy people by atlas?based analysis (ABA), and to investigate the respective relationship with cognitive function. Methods Twenty?one AD patients (AD group), 8 MCI patients (MCI group) and 15 normal controls (control group) were performed by conventional MRI and diffusion tensor imaging (DTI). The raw data of DTI was processed by using DTI studio software to generate the fractional anisotropy (FA) images. Then ABA was used to quantify the FA value in 58 deep GM and WM structures. The differences of FA value among three groups were compared by using one way ANOVA, with a post?hoc analysis. In AD and MCI groups, the partial correlation was further investigated between mini?mental state examination (MMSE) score and FA value in the brain regions that have significant differences between AD and MCI group or between MCI and control group. Results Compared with control group, AD patients showed wide?spread FA decrease in most deep GM and WM regions (corrected P<0.05). The FA values of the hypothalamus, the fornix, the superior longitudinal fasciculus (SLF) and the cingulum in AD group were significantly lower than those in MCI group (corrected P<0.05). The FA value of the right splenium of corpus callosum (SCC) in MCI group was significantly lower than that in control group (MCI:0.550±0.018 vs. Control:0.585±0.026, P<0.05). In AD and MCI group, the FA values of the left hypothalamus, the right hypothalamus, the left cingulum, the right cingulum, and the left SLF were positively correlated with MMSE scores(r=0.502, 0.515, 0.535, 0.527, 0.512; P<0.05). No significant correlation was found between the FA value of the right SCC, the right SLF, the right fornix/stria terminalis, the right fornix and MMSE scores(P>0.05). Conclusion Based on ABA, this study found the diffusion changes not only in the WM but also the deep GM in AD patients, but only WM diffusion disruptions in MCI group. The decreased FA value in the right SCC appeared early, but had no correlation with the cognitive impairment. The FA value in the hypothalamus, the fornix, the SLF and the cingulum decreased with the disease progression, and correlated positively with the cognition decline.

Objective To investigate the clinical parameters,risk factors,treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective a-nalysis was made for the clinical features,risk factors,treatment and prognoses of the non-HIV infected severe PCP pa-tients hospitalized at Pediatric Intensive Care Unit( PICU) of Children′s Hospital Affiliated to Capital Institute of Pedi-atrics. Results During April of 2010 to April of 2014,there were 10 cases of non-HIV infected severe PCP in PICU of Children′s Hospital Affiliated to Capital Institute of Pediatrics. All of the patients had predisposing diseases,in which 3 cases had connective tissue diseases,2 cases had acute leukemia,3 cases had severe pneumonia and 2 cases had con-genital immunodeficiency. The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea. All patients developed respiratory failure. The median value of Pediatric Critical Illness Score was 79. The median arterial oxygen pressure was 58 mmHg(1 mmHg=0. 133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43. 8 mmHg. The median CD4+T-lympho-cytes counts was 169 ×106/L. Eight patients on admission had mixed infection. Acute respiratory distress syndrome (ARDS) occurred in all of the patients,and 7 cases of them had multiple organ dysfunctions. All of the patients re-quired ventilation support. The median day for invasive mechanical ventilation days was 11 and the median day for non-invasive ventilation days was 6. The pneumothorax occurred in 5 patients. All patients received trimethoprim-Sulfame-thoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients. Six patients had nosoco-mial infection. The median time of PICU stay was 15. 5 days. Six patients survived and the mortality was 40%(4/10 cases) . Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions. Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children.

Objective To determine the effect of age,body figure and risk framing in making treatment decision for female patients with breast cancer.Methods Two groups of healthy female:one group of 60 female ages 18-24 from undergraduate student and the other group of 60 female ages 35-60 from the university community.Healthy women imagined that they had been diagnosed with breast cancer and received information regarding lumpectomy versus mastectomy and recurrence rates.Participants indicated whether they would choose lumpectomy or mastectomy and reasons.Results The different concern levels of body appearance between younger and older women influences treatment selection of lumpectomy versus mastectomy.Facing the risk information,older women were unlikely to select the breast conserving operation.Conclusions The factors of age and the attention to body figure would effect the choice of breast conserving operation or mastectomy.Risk information on the selection of treatment would not affected directly,but the effects of risk information on younger and older female is different.Nurses should provide the age-appropriate information who recently have been diagnosed with breast cancer regarding treatment alternatives to ensure their active participation in the decision-making process,female who have different levels of investment in body figure also may have different concerns about treatment,and should be alert on empathetic of such concerns.

Objective To observe the formation of the biofilm in endotracheal tubes,the characteris-tics of etiology, drug resistance and relationship between the biofilm and ventilator-associated pneumonia ( VAP) . Methods A total of 60 cases of ventilated children patients whose mechanical ventilation time were≥48 h in the ICU from September 2010 to September 2012,according to the mechanical ventilation time,all cases were divided into 2 to 6 d group,7 to 14 d group and ≥15 d group. The incidence of VAP, biofilm structure under the electron microscope,etiology culture positive rate of the lower airway secretions and bio-film,etiological characteristics and drug resistance were prospectively studied. Results ( 1 ) A total of 19 cases occurred VAP in 60 cases of mechanical ventilation,the incidence of VAP was 31. 7%. (2) Observed by electron microscope,biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation. With prolonged mechanical ventilation,biofilm structure had improved,as well as VAP incidence rate from 9. 1%(2 to 6 d group ) increased to 44. 4%(7 to 14 d group) and 88. 9%(≥15 d group). (3) A large number of pathogenic bacteria colonized in the biofilm. Gram-negative bacilli were dominate and drug resistance was high. (4) With prolonged mechanical ventilation,the cultured pathogens from the lower airway secretions and biofilm converged. Conclusion Biofilm could form in the endotracheal tube with mechanical ventilation patients,and is associated with the occurrence of VAP and refractory infections.

Objective: To investigate the effects of high mobility group box-1 protein (HMGB1) exocrine promoted by G protein-coupled estrogen receptor (GPER) in cancer-associated fibroblast (CAF) combined with the small molecule compound G1 on the autophagy and proliferation of breast cancer MCF-7 cells. Methods: The GPER-shRNA lentiviral vector specifically interfering GPER gene expression was constructed and used to infect CAF (CAF-shGPER), while the CAF infected with a negative control lentivirus was used as the control (CAF-shNC). The expression levels of GPER mRNA and protein in CAF-shNC and CAF-shGPER cells were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. The GPER-specific agonist G1 was used to treat the CAF-shNC and CAF-shGPER cells, respectively. Then the expression levels of HMGB1 mRNA and protein in CAF-shNC, CAF-shGPER, CAF-shNC+G1 and CAF-shGPER+G1 cells were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. The secretion of HMGB1 protein in the conditioned medium of four groups was detected by enzyme-linked immunosorbent assay (ELISA). The conditioned medium of four groups was collected and used to treat MCF-7 cells. Then the expression levels of Beclin1, p62 and LC3 proteins in MCF-7 cells were detected by Western blotting, while the proliferation of MCF-7 cells was detected by CCK-8 assay. Results: After the lentivirus carrying GPER-shRNA was stably infected into CAF, the expressions of GPER mRNA and protein were significantly inhibited (both P<0.01). The expressions of HMGB1 mRNA and protein in CAF-shNC cells were significantly up-regulated by GPER specific agonist G1 (both P<0.05), while the secretion of HMGB1 was increased in the conditioned medium (P<0.05); However, the above effects of G1 were opposite in CAF-shGPER cells. Furthermore, the exocrine HMGB1 in conditioned medium up-regulated the expressions of Beclin1 and LC3 proteins (both P<0.01), down-regulated the expression of p62 protein (P<0.01), and increased the autophagy and proliferation abilities of MCF-7 cells (both P<0.01). Conclusion: The small molecule compound G1 can promote the expression of GPER in CAF in tumor microenvironment and increase the secretion of cytokine HMGB1, thus induce the autophagy of MCF-7 cells and promote the growth of MCF-7 cells.

Objective:To evaluate the characteristics of carotid plaque and the immediate outcomes after carotid artery stenting (CAS) in diabetic and non-diabetic patients by optical coherence tomography (OCT).Methods:Patients underwent CAS and OCT before and after operation in the Department of Neurology, Jinling Hospital from January 2014 to March 2019 were enrolled retrospectively. The clinical features, the characteristics of carotid plaque on OCT and the immediate outcomes after CAS were compared between diabetic group and non-diabetic group. The risk factors of stent malapposition were analyzed.Results:A total of 46 patients were enrolled. Their age was 64.02±8.32 years and 41 were males (89.1%). There were 20 patients (43.5%) in the diabetes group and 26 (56.5%) in the non-diabetes group. The proportions of atherosclerotic plaque with thin fibrous cap (40.0% vs. 7.7%; χ2=5.166, P=0.023), plaque rupture (55.0% vs. 23.1%; χ2=4.945, P=0.026) and macrophage infiltration (60.0% vs. 30.8%; χ2=3.930, P=0.047) in the diabetic group were significantly higher than those in the non-diabetic group. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.208, 95% confidence interval [ CI] 1.033-1.413; P=0.018), coronary heart disease ( OR 15.953, 95% CI 1.142-222.952; P=0.040), alcohol consumption ( OR 6.192, 95% CI 1.098-34.923; P=0.039) and lower systolic blood pressure ( OR 0.944, 95% CI 0.894-0.997; P=0.037) were independently associated with stent malaposition. Conclusion:Compared with the non-diabetic patients, carotid plaque in diabetic patients may be more unstable. Older age, coronary heart disease, alcohol consumption and lower systolic blood pressure were associated with stent malaposition after carotid stenting. OCT can reveal the characteristics of carotid plaque and the immediate outcomes after CAS, which can provide strong evidence for treatment decision.

Objective:To investigate the correlation between mental health and symptom distress in breast cancer patients.Methods:The clinical data of 110 female breast cancer patients at Shanxi Bethune Hospital from June 2017 to March 2018 were collected. The patients were assessed for symptomatic distress with depression self-rating scale (SDS). Functional assessment of cancer therapy-breast (FACT-B) and the functional assessment of chronic illness therapy-spiritual well-being (FACIT-SP) were used to make the mental assessment. Multiple linear regression analysis was used to analyze the effect of symptom distress on the mental health of the patients.Results:The scores of symptom distress, mental health, FACT-B and FACIT-SP were (19.94±5.78), (50.68±10.64), (16.85±4.75), (33.83±8.33), respectively. Multivariate analysis showed that mental health score of the patients with symptom distress > 18 scores was reduced by 5.15 points ( P=0.01) compared with the patients with symptom distress≤18 scores. Compared with the patients with annual household income < 50 000 yuan, the mental health score of patients with annual household income of 50 000-79 000 yuan was increased by 9.46 points ( P < 0.01), and the mental health score of patients with annual family income ≥ 80 000 yuan was increased by 5.92 points ( P < 0.01); compared with the patients in phase I, the mental health score of the patients in phaseⅡwas decreased by 2.62 points ( P=0.02), and the mental health score of the patients in phase Ⅲ was decreased by 4.98 points ( P < 0.01). Conclusions:Symptom distress is an independent risk factor for affecting mental health of breast cancer patients. Solving symptom distress of patients can improve mental health status of the patients.

Objective To observe the formation of the biofilm in endotracheal tubes,the characteristics of etiology,drug resistance and effect on the biofilm and ventilator-associated pneumonia (VAP) of inhaled N-acetylcysteine (NAC).Method We selected 117 tracheally intubated and undergoing mechanical ventilation for ≥48 h in our hospital ICU from September 2010 to August 2012.All the cases were randomly divided into control group (60 cases) and study group (57 cases).The patients in the study group were treated with different doses of aerosolized NAC according to different ages,starting the first administration within 12 hours of mechanical ventilation,once every 8 hours,until stopping mechanical ventilation.Comparison was performed on the two groups in biofilm structure under the scanning electron microscopy,biofilm culture positive rate,VAP incidence,the etiology and drug resistance of the lower airway secretions and biofilms.Result (1) Electron microscopy showed that biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation.With prolonged mechanical ventilation,biofilm structure improved.At the same time of mechanical ventilation,the thickness of biofilm in the study group decreased as compared with the control group.(2) Biofilm culture positive rate and incidence of ventilator-associated pneumonia decreased in the study group compared with in the control group (65％(37/57) vs.80％(48/60),P＜0.05;11％ (6/57)vs.32％(19/60),P＜0.01).(3) Alarge number of pathogenic bacteria colonized in the biofilm and gram-negative bacilli dominated.With prolonged mechanicalventilation,theculturedpathogensconvergedfromthelowerairwaysecretionsandbiofilm.Conclusion With prolonged mechanical ventilation,biofilm structure was improved.Inhalation of NAC can inhibit biofilm formation and reduce the incidence of VAP.