Acute kidney injury (AKI) is a common and serious clinical syndrome after cardiac surgery with the high morbidity and mortality.As the markers of AKI,Serum creatinine and urine output is not sensitive for early detection.Due to the lack of early biomakers for AKI,early effective treatment has been delayed.Identification of novel biomarkers for AKI has progressed to the clinical phase.Novel biomakers include neutrophil gelatinase-associated lipocalin,kidney injury molecule-1,Cystatin C,IL-18,and so on.In this article the author will review the current progress of these clinical and experimental novel AKI biomarkers.

ObjectiveTo investigate the characteristics of three vaginal bacteria inspection methods of Amsel method,gram staining Nugent score method and bacterial vaginosis (BV) Blue methodMethods The leucorrhea specimen of 99 vaginal fluid abnormal patients were examined by Amsel method,gram staining Nugent score method and BV Blue method,then compared and analyzedResultsThe positive rate was 28.28％ (28/99) in Amsel method,47.47％(47/99) in gram staining Nugent score method and 16.16％ (16/99) in BV Blue method.There were significant differences among three methods(P＜ 0.01 ).The specificity and sensitivity of gram staining Nugent score method was higher.ConclusionThe three vaginal bacteria inspection methods have advantage and shortcoming individually,suspecting patients should be followed up to detect and diagnose in chnic,or detected by many methods.The specificity and sensitivity of gram staining Nugent score method is higher,but BV Blue method is simple,faster,which has higher value in detection and diagnosis in BV.

Objective To analyze the risk factors leading to prolonged mechanical ventilation following valve replacement surgery with the purpose of improving the management of these patients.Methods The risk factors of prolonged mechanical ventilation at preoperative,operative and postoperative clinical data of 307 patients who underwent valve replacement surgery were retrospectively analyzed.Binary Logistic regression model was used to assess the factors.Results The time of mechanical ventilation after valve replacement surgery was (15 ± 35) h,and 31.6％ (97/307) of these patients underwent prolonged mechanical ventilation (＞ 8 h).Age ≥ 65 years (P =0.003),smoker (P =0.024),left ventricular ejection fraction (LVEF) preoperative (P =0.002),duration of operation (P =0.000),aortic block time (P =0.046),cardiopulmonary bypass time (P =0.030),number of replaced valve (P =0.001),volume of postoperative chest drainage (P =0.000) and postoperative complications (P =0.010) were risk factors of prolonged mechanical ventilation.Logistic regression analysis showed that LVEF (P =0.026),duration of operation(P =0.037),aortic block time (P =0.001),cardiopulmonary bypass time (P =0.013),number of replaced valve (P =0.017),volume of postoperative chest drainage (P =0.020) and postoperative complications (P =0.014) had extremely affection.Conclusions Greater importance should be attached to healthcare education,early treatment to avoid multivalvular involvement,preoperative heart function regulation,lower duration of operation especially aortic block time and cardiopulmonary bypass time,lower postoperative chest drainage and better preservation of organs during operation to decrease the rate of prolonged mechanical ventilation and optimize the clinical quality.

Objective To investigate the correlation between serum cystatin C(Cys-C)and renal function in patients with renal damage secondary to cirrhosis.Methods 129 patients with liver cirrhosis were selected,according to the measured glomerular filtration rate (GFR) as the gold standard for evaluation of renal function,patients were divided into group A(cirrhosis with normal renal function),group B(cirrhosis following renal insufficiency),group C (cirrhosis secondary to renal failure).The concentration of Cys-C was compared among three groups,and the serum creatinine(Scr),serum proteins ball micro β2 (β2-MG),creatinine clearance (Ccr) were detected.Results Cys-C,Scr,β2-MG,Ccr and other indicators of A,B,C three groups increased or decreased with the severity of impaired renal function(t =6.65,6.85,6.58,4.54,all P ＜ 0.05).The abnormal detection rates of Cys-C,Scr,Ccr,β2-MG in A group were 31.1％,11.1％,8.9％,26,7％,those in B group were 83.7％,30.2 ％,34.9％,46.5％,those in C group were 100.0％,85.4％,87.8％,95.1％.Conclusion Serum Cys-C concentration is a sensitive marker to evaluate glomerular filtration,it has accurate and reliable clinical significance in the early diagnosis of liver cirrhosis secondary to kidney damage.

Objective To evaluate the hypothesis that neutrophil gelatinase-associated lipocalin(NGAL) ,kidney injury molecule-1(KIM-1)and Interleukin-18(IL-18) are early biomarker for acute kidney injury (AKI) in patients after coronary artery bypass graft surgery(CABG) .Methods 80 patients were recruited during September 2011 to May 2012 .The patients were divided into two groups according to the AKI criteria ,patients developed postoperative AKI in AKI group ;others did not postoperative developed AKI in non-AKI group .Before and 2 ,4 ,6 ,8 ,12 ,24 h after the CABG surgery ,the urine and serum sample were collected ,serum creatinine ,the urine and serum IL-18、NGAL、KIM-1 value were test by ELISA method .Results 13 of 80 cases(16 .25% )developed postoperative AKI according to the AKI criteria ,diagnosis with serum creatinine was only 12-48 h after cardiac surgery .Concen-trations of NGAL 、IL-18 in urine and serum at 2 h after CABG surgery ,concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI by logistic regression analysis and ROC curve .Conclusion IL-18 in urine and serum at 2 h after CABG surgery were the powerful independent predictors of AKI ,and concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI .Serous NGAL and IL-18 is better than urinary NGAL and IL-18 in diagnosis of AKI . Urinary KIM-1 was better than serous KIM-1 in diagnosis of AKI at 6 h .

Objective To investigate the correlation of possible risk factors with acute renal injury (AKI) after coronary artery bypass surgery (CABG) and explore if the incidence of AKI could be lower by off-pump CABG for kidney protection.Methods Two hundred and nine patients who underwent coronary artery bypass surgery in Nanjing First Hospital from September 2010 to November 2013 were recruited.The patients were divided into AKI group (fifty-five cases) and non-AKI group (one hundred and fifty-four cases) according to the AKI criteria and compared the possible risk factors between two the groups by univariate analysis and multivariate analysis.Results The index of female gender,body mass index,age,hypertension,basic serum creatinine,ejection fraction,the number of coronary atherosclerosis,cardiopulmonary bypass,IABP for circulatory support,postoperative low cardiac output,lactate in AKI group were higher than that in non-AKI group by univariate analysis (P ＜ 0.05).And basic serum creatinine,ejection fraction,cardiopulmonary bypass,postoperative low cardiac output showed a significantly statistical difference between two group by multivariate analysis.Conclusions Cardiopulmonary bypass,basic serum creatinine,ejection fraction,postoperative low cardiac output were independent risk factors.Off-pump CABG could benefit for kidney protection.

Objective To investigate the effects of dexmedetomidine on the inflammatory response during the aortic dissection perioperative period.Methods 53 patients with the type A aortic dissection who needed surgical treatment were randomly divided into the study group and the control group.Patients in the study group (group A) received dexmedetomidine (0.2-0.7 μg · kg-1 · h-1) while patients in the control group (group B) received morphine 0.2-0.6 mg/h to ease pain after they were admitted and continued to 48 h after the operation.The serum levels of TNF-α,MMPs,NE,NT-proBNP and CRP were measured in the patients at the time enrolled taking none of the two drugs(T0),before the operation(T1),immediately after the operation (T2) and 12 h (T3),24 h (T4),48 h (T5),72 h (T6) after the operation.MODS score and the length of stay in ICU were observed about the two groups of patients.Difference between the two groups was determined by the Student' s t-test.Single factor analysis of variance was used within the group.P ＜ 0.05 was considered statistically significant.Results Compared with the patients in group B,the MMPs levels in group A at 24、48 and 72 h after the operation were significantly lower.The patients in group A had lower levels of NT-proBNP and NE both at 48 h and 72 h after the operation.Lower levels of TNF-α and CRP were also found at 24 h and 48 h in this group.The MODS score at the fifth 、tenth and 15th day after the surgery were both significantly lower than that of the first day in patients of group A.Conclusion Dexmedetomidine can inhibit the inflammatory response during the aortic dissection perioperative period and can reduce the acute injury of organs caused by the excessive systemic inflammatory response.

Objective To test the hypothesis that interleukin-18 (IL-18) in the urine and serum sample are early biomarker for acute kidney injury (AKI) in patients after coronary artery bypass graft surgery (CABG).Methods Eighty patients who underwent CABG were recruited.The patients were divided into AKI group and non-AKI group according to the AKI criteria.The urine and serum sample were collected at pre-operation and 2 h,4 h,6 h,8 h,12 h,24 h after the CABG.The urine and serum IL-18 value were test by ELISA method.Receiver-operating characteristic cue(ORC) and the area under the cure(AUC) asses the sensitivity and specificity of IL-18 for AKI.Results Thirteen of eighty cases(16.25％) developed postoperative AKI according to the AKI criteria.Diagnosis with creatinine was only 24-48 hours after CABG.The serum and urinary concentrations of IL-18 at mostly each time point after CABG in AKI patients were significantly higher than those in non-AKI patients(P ＜ 0.01).Urinary and serous concentrations of IL-18 peaked at 4 h after CABG in AKI patients.ROC curve showed AUC in urinary and serous concentrations of IL-18 at 2 h ＞ 0.8 ; Concentrations of IL-18 in urine and serum at 2 h were the powerful independent predictors of AKI by logistic regression analysis.Conclusion IL-18 in urine and serum after CABG surgery were the powerful independent predictors of AKI.

Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.Methods From June 2006 to June 2010,91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtüller long-stem cementless implant.There were 35 males and 56 females,with an average age of 81.2 years (range,75-94 years).There were fresh fractures in 75 cases and old fractures in 16 cases.According to classification of Evans-Jensen,there were 36 cases with type Ⅲ fracture and 55 with type Ⅳ.Osteoporosis was graded by Singh index,and there were 51 cases with level Ⅲ and 40 with level Ⅱ.The interval between injury and operation was 2-10 d (average,3.5 d).Results The surgery lasted 30-50 min (average,39 min).The blood loss was 320-610 ml (average,405 ml).The hospital stay was 14-21 d (average,16.5 d).Two cases who experienced with the infection of the respiratory system after operation,recovered through routine treatment.Thirty-seven cases were followed up for 15 to 38 months (average,24.5 months).According to the Harris score,the overall rate of excellent or good result was 83.8％ (31/37).Conclusion Hemiarthroplasty using Zweymüller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.

Objective:To investigate the effects of superagonistic CD28~- specific monoclonal antibody JJ316 (supCD28 MAb) on preferentially expanded rat CD4~+CD25~+Treg (Treg) cells in vivo and its applicability in obliterative airway disease (OAD).Methods:The heterotopic tracheal transplantation model in rats was used.One group received mIgG-treatment(0.5 mg/rat) as control.The experimental group was treated with supCD28 Mab(0.5 mg/rat) via intraperitoneal injection on the day of transplantation.The changes of Treg cell population in cervical lymph nodes were monitored by flow cytometry after 7 days.Tracheas were harvested after 21 days for further histologic evaluation.Results:SupCD28 MAb administration was revealed with a significant increase in the CD4~+CD25~+ T and CD4~+Foxp3~+ T cells population in cervical lymph nodes compared to treatment with mIgG group on day 7 after transplantation,[8.5%±3.4% and 11.5%±2.7% (P<0.05 vs mIgG group)in the supCD28 Mab group,1.8%±1.9% and 3.2%±2.1% in the mIgG group,respectively].Furthermore,the allografts from animals treated with supCD28 MAb were significantly less airway obliteration and destruction of the epithelium compared with that of control group animals on day 21 after transplantation.Conclusion:SupCD28 MAb targets expansion of Treg cells and attenuates airway lumen obliteration in rat obliterative airway disease.