Acute kidney injury(AKI) is a common clinical severe emergency in children,with high morbidity,mortality and poor prognosis.The traditional indicators such as serum creatinine and urine can't diagnose early.Recently,with the deepening research of AKI,many higher specific and sensitive biomarkers have been found.But the study of biomarkers in children is behind the adult,and the etiology,pathophysiology of AKI in children have great difference from adult.So this paper will show the advances of biomarkers in children of AKI.

Objective To verify the targeting regulatory relationship between microRNA (miR)-21-5p and mitogen-activated protein kinase kinase 3 (MKK3).Methods miR-21-5p and MKK3 targeted relationship was analyzed by bioinformatics database predict.Constructing MKK3 3'UTR reporter vector (MKK3-3U) and mutation reporter vector (MKK3-3 U-M) was constructed by synthesizing miR-21-5p mimics (mimic),miR-2 1-5p inhibitor (inhibitor),nonsense miR (NC).NC (NC1 group),mimics (mimic1 group),inhibitor (inhibitor1 group) together with MKK3-3U cotransfected human embryonic kidney (HEK293) cells,respectively.Empty vector-pYr-MirTarget (NC2 group),MKK33U (Mt group),M KK3-3U-M (Mut group) together with mimic co-transfected HEK293,respectively.The fluorescence ratio was detected by dual luciferase assay.NC,mimics,inhibitor intervened human renal tubular epithelial (HK-2) cells,respectively.RT-PCR and Western blot were used to test cell MKK3 expression level in HK-2.Results 1.The fluorescence ratios of NC1 group,mimicsl group,and inhibitor1 group were 100.00％,67.99％,133.17％,and there was difference between mimic1 group and NC1 group(t =19.93,P ＜ 0.05).2.The fluorescence ratios of NC2 group,Mt group and Mut group were 100.00％,65.30％,98.48％,and there was difference between Mt group and NC2 group (t =14.39,P ＜ 0.05).There was no significant difference between NC2 and Mut group (t =0.63,P ＞ 0.05).3.MKK3 mRNA relative expression levels of the control group mimic2 group and inhibitor2 group were 1.36 ± 0.02,1.01 ± 0.04,1.43 ± 0.06 ; relative protein expression levels were 0.97 ± 0.05,0.62 ± 0.06,1.36 ± 0.32.MKK3 mRNA and protein levels of mimic2 group were significantly lower compared with the control group (F =85.98,118.26,all P ＜ 0.01).Conclusions MKK3 is the target gene of miR-21-5p.miR-21-5p can regulate the expression of MKK3 both in mRNA and protein levels.miR-21-5p may be an important regulatory molecule in p38 mitogen-activated protein kinase signaling pathway.

Patients with SAP have a hypermetabolic and hypercatabolic state.Nutritional support for patients with SAP is needed.EN by the jejunal route does not stimulate pancreatic secretions and is safe.At present,the beneficeal effects of EN towards improving the nutritional condition,protecting gut barrier function,reducing translocation of bacteria and endotoxins,modulating the inflammatory response,and decreasing the cost have been observed.Therefore,the EN rather than PN should be used by the jejunal route to provide nutritional support for patients with SAP.

Objective To discuss the therapeutic effect of recombinant human CTLA-4Ig fusion protein (rhCTLA-4Ig) on rheumatoid arthritis (RA) patients and the change of T helper cells 17 (Th1 7 ) and regulatory T (Treg) cells.Methods Forty-eight active RA patients were randomly divided into the treatment group and the control group.Treatment group received 12 weeks of infusions of rhCTLA-4Ig ( 10 mg/kg),while the control group received 12 weeks of infusions of placebo.The changes of expression levels of Th17cell were detected by flow cytometry.The changes of expression level of FoxP3 in monocytes of the peripheral blood were examined by RT-PCR.T test and x2 test were used for statistical analysis.Results ① Eighteen of 24 cases in treatment group showed good ACR20 changes after 12 weeks,the effective rate (75％) was significantly higher than that of the control group ( 1/24,4％ ).After treatment,DAS28 score of the treatment group (3.0±0.7) was significantly lower than that of the control group(6.9±0.7) (t=-12.39,P＜0.01 ).② Compared with the Th17 monocytes of the peripheral blood from active RA patients of treatment group after therapy (0.22±0.20)％,the Th17 monocytes of peripheral blood from active RA patients of the control group (1.63±0.47)％ were higher (t=5.61,P＜0.05 ).③ Compared with the FoxP3 mRNA of the control group (0.24±0.05),that of the treatment group (0.88±0.18) was significantly higher after therapy (t=7.56,P＜0.01 ).Conclusion The clinical parameters of RA patients have improved significantly after the treatment,and the Th17 and Treg cells balance is also restored after rhCTLA-4Ig therapy.

Cervical artery dissection (CeAD) is characterized by an intramural hematoma of the internal carotid artery or the vertebral artery.CeAD is the major cause of ischemic stroke in young adults.Carotid artery dissection is a major cause of stroke.Early recognition and treatment of CeAD is important for the prevention of ischemic stroke.

Objective To explore the factors influencing the intra-laboratory turnaround time ( ILTAT) and establish a COX regression model.Methods Data of 5 weeks with a total of 904 cases from the samples of blood routine examinations from January 2014 to June 2014 in The Third Hospital of Xingtai were randomly collected.The records of the samples included test dates , times of arrival , times of test , sample statuses, time consumption, time duration, operators, project portfolios, delay, PLT counts, results of 30-minute treatment and test weeks.Based on SPSS 17.0, the above indicators were analyzed by COX single factor analysis and then COX mutiple-factor regression analysis.Results Within the prescribed time , 421 cases were sent taking up 46.6%of the total samples.The ratios of sent cases in 10, 20, 30, 40 and 50 minutes are 10.4%, 24.7%, 46.6%, 58.7% and 82.1% respectively.The results of COX single factor analysis showed that times of arrival , sample statuses, times of examination, operators, project portfolios and delay had statistical significance for ILTAT ( P<0.05 ).The results of COX multiple-factor analysis indicated that right times of arrival had a positive impact in reducing the turnaround time of samples (Wald=40.446,P=0.000);non-office hours, project portfolios, physical check samples, and handovers were unfavorable factors to shorten ILTAT ( Wald =7.904,38.029,42.874,18.617, P =0.005,0.000, 0.000,0.000);Operator 5 was a favorable factor(Wald=11.039, P=0.001) and Operator 3 and Operator 10 were unfavorable factors ( Wald =6.432, 24.242, P =0.011, 0.000 ); no obvious discrepancy was observed for other operators (P>0.05).Conclusions Times of arrival, times of test, operators, project portfolios and delay were the independent risk factors leading to the delay in ILTAT.Other laboratories could determine the variable number of proportional hazards models based on their sample transport , test procedures and principal influence factors , and carry out quantitative evaluation on the factors in sample processing for improvement.Thus, significant decrease on ILTAT would be achieved.

Objective To investigate the clinical significance of the three iodide transporters in thyroid diseases. Methods Literatures about the Na+/I-symporter (NIS), pendrin and human apical iodide transporter (hAIT) in recent years were reviewed and their expressions in different thyroid diseases were also analyzed. Results NIS proteins express at the basolateral membrane of thyrocytes in normal thyroid tissue, while pendrin and hAIT proteins are limited to the apical membrane of thyrocytes lining in the follicular lumen. In the tissues of thyroid carcinomas, it was found that the NIS proteins expressed in the cytoplasm and their expressions decreased; The mutation of NIS gene may be one of the main causes of congenital hypothyroidism. The expression of prendrin protein may be related to the function of follicles: its expression level increased significantly both in Graves diseases and toxic adenomas, but significantly decreased in differentiated thyroid carcinoma. However, the correlation between the decrease and the degrees of differentiation of carcinoma cell line are still disputable. The expression of hAIT protein does not significantly altered in hyperfunctioning tissues. It only slightly decreased occasionally in hypofunctioning adenomas, but it decreased significantly in thyroid carcinomas. Conclusion The abnormal expressions of the three iodide transporters may be related closely with the type of thyroid diseases. However, their pathogenic mechanisms and the causes of their abnormal expression are still unknown, which need to be studied further.

Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). MethodsOne hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. ResultsThere was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P

Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection,exposure and protection of the RLN during the surgical procedures. Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact,the rest 2 nerves were resected because of tumor involving. Conclusion s NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery,especially reoperation.

ObjectiveTo investigate the incidence, clinical features and preventive measurement of secondary hepato-biliary neoplasm (HBN) in patients with hepatolithiasis. MethodA clinical retrospective study was made on 27 hepatobiliary malignancy patients found among 556 consecutively admitted cases of hepatolithiasis from Jan. 1996 to Sep. 2000.Results The average incidence of hepatobiliary malignancy in patients with hepatolithiasis is 4.8%. In this series, preoperative definite diagnosis was made in 4 cases (4/27, 14.8%). Atypical liver abscess, refractory biliary system infection, progressive obstructive jaundice, CT or BUS scan abnormal findings, and epigastric masses are all clues to concurrent malignancy in patients of hepatolithiasis. ConclusionThere is high incidence of hepatobiliary malignancy in hepatolithiasis patients. Prophylactic partial hepatectomy for segments with stone and chronic infection may be an important measure to prevent ensuing malignancy.