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.

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 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.

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.

Pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome is a rare autoinflammatory bone disease, which caused by proline-serine-threonine phosphatase interacting protein 1 (PSTPIP1) gene mutations.Due to a lack of awareness of it among clinicians, PAPA syndrome is hard to diagnose and easy to be misdiagnosed or miss-diagnosed clinically.In this paper, twin brothers with recurrent fever and joints pain were reported.They were diagnosed with suppurative arthritis by many hospitals, but after receiving the joint cavity incision operation with negative pressure drainage for several times and antibiotics treatment, their conditions were not improved.Genetic tests showed that the twin brothers had a heterozygous mutation p. E250K (NM003978.3; c.748 G>A; p.Glu250Lys) on the PSTPIP1 gene.They were finally diagnosed with PAPA syndrome and improved with glucocorticoid therapy.

Objective Color-coded digital substraction angiography (CC-DSA) was based on DSA and takes image postprocessing via corresponding software (iFlow or Angioviz).It can observe the change of datas,which will be used to analysis the hemodynamics.CC-DSA has advantages of high temporal and spatal resolution.Meanwhile it spends less time and dose not increase the quantity of contrast-medium and X-ray.The application of CC-DSA in recent years were reviewed in this paper.

Toxic epidermal necrolysis (TEN) is an acute skin inflammation,which belongs to heavy drug eruption.With the extensive and widespread use of antibiotics,nonsteroidal antipyretic analgesics and other pharmacotherapies in the treatment of critically ill patients,the trend of morbidity of TEN is gradually increased,especially in intensive care unit.In consideration of the high mortality rate of TEN and its great influence on the overall prognosis of patients with critical illness,we summarized the diagnosis and treatment experiences in the management of TEN based on retrospective analysis of one patient with severe acute pancreatitis and TEN.

Objective To observe clinical effect of treating glaucoma with compound trabeeuleetomy combined with activating blood circulation and promoting diuresis Chinese medicine. Methods 42 cases with glaucoma were randomly divided into two groups by means of random number table. The control group was treated with compound trabeculeetomy, and the treatment group was treated with Chinese medicine after compound trabeeuleetomy. The regular reexamination was performed, and follow-up visit was executed for an average of 12 months. Results Compared with the control group, the postoperative vision in the treatment group increased significantly (λ2=4.511, P<0.05) , and intraocular pressure decreased significantly (λ2=3.638,P< 0.05); The rate of anterior chamber in the treatment group was lower than that of the control group(λ2=4.256 P< 0.05) . Both groups had filtering bleb, and the rate of non-functional filter blebs in the treatment group was lower than that of the control group (λ2=3.054, P< 0.05 ) . Conclusion The therapy of compound trabeculectomy combined with Chinese medicine on glaucoma was better than compound trabeculeetomy only.

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.

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.