Objective To evaluate whether three chronic kidney disease epidemiology collaboration (CKD-EPI) equations (CKD-EPI2009Scr,CKD-EPI2012SCysC and CKD-EPI2012Scr-SCysC) are applicable in the prediction of glomerular filtration rate (GFR) in Chinese patients with diabetic nephropathy (DN).Methods One hundred and eight patients with DN who were hospitalized in the First Affiliated Hospital of Guangzhou Medical University with GFR being measured by dynamic renal imaging with 99mTc-DTPA from June 2012 to April 2014 were enrolled in this study.GFR measured by dynamic renal imaging with 99mTe-DTPA was used as the reference value (rGFR).GFR was estimated by the CKD-EPI2009Scr equation,the CKD-EPI2012SCySC equation,and the CKD-EPI2012Scr-SCysC equation (labeled as eGFR1,eGFR2,eGFR3).The correlation,30％ accuracy,staging consistency,deviation and diagnostic accuracy were compared among the three CKD-EPI equations.Results The rGFR in 108 DN patients was (61.78±26.51) ml· min-1· (1.73 m2)-1.The correlation between three eGFRs and rGFR was significant (all P ＜ 0.01),the correlation coefficients were 0.738,0.708,0.782.The 30％ accuracy were 74.07％,52.78％,67.59％,The 30％ accuracy of eGFR1 and eGFR3 were higher than eGFR2 (all P ＜ 0.05),but there was no significant difference between eGFR3 and eGFR1 (x2=0.874,P=0.436).The staging consistency was not ideal,Kappa values were 0.391,0.180 and 0.422.For the deviations between three eGFRs and rGFR,there was no significant difference between eGFR3 and rGFR (P ＞ 0.05),eGFR1 underestimated rGFR,eGFR2 overestimated rGFR (all P ＜ 0.01).The results of the Bland-Altman chart showed that consistencies between three eGFRs and rGFR were poor,the degree of deviation of eGFR3 was the smallest.The area under the ROC curve (AUC) of three eGFRs was 0.878,0.883 and 0.915.The AUC,sensitivity,specificity,overall compliance rate and Youden index of eGFR3 were the highest.Conclusions The eGFRs predicted by the three CKD-EPI equations showed good relevance,accuracy and diagnostic accuracy with the rGFR,but poor in consistencies.Comparatively,CKD-EPI2012Scr-SCysC may be better than others,but its consistency limits exceeds the acceptable limits.Therefore,the applicability of using the three CKD-EPI equations to predict the GFR in Chinese DN patients requires a larger sample and multiple verifications as well as further improvement.

Objective To evaluate the prevalence of NI in the SICU at our hospital. Methods 181 NI patients in the SICU were retrospectively analysed during Jan 1996～Dec 2000.Results The average NI rate was 9.81%. The major sites of NI were respiratory tract(36.96 %),thoracic/abdominal cavity(25.47 %)and bloodstream infections(9.32 %).The difference in major pathogens of infections in different sites reached statistical significance. For respiratory tract, thoracic/abdominal cavity and bloodstream infections,bacteria were the most common pathogens. Fungi were the moat frequent isolate from urine and stool. Mixed infection proportion was 52.25 %. The most common pathogens were Enterococci, Methicillin resistant Staphylococci、 Pseudomonas Aecruginosa、Escherichia Coli、Candida Albicans and Candida Tropicalis. Conclusions The most common pathogens of NI in SICU are different in different infection sites. The pathogens were complicated and most strains are antibiotics resistant. So it is important to establish NI control and to understand the changes of pathogens so as to prevent the infection.

Objective To investigate whether myeloid-derived suppressor cells (MDSCs) have a protective effect in septic mice. Methods The model of caecal ligation and puncture (CLP) was performed to induce polymicrobial sepsis in mice. The changes of MDSCs in spleens at different times after operation were studied. In order to observe the influence of MDSCs on the inflammatory factors and survival of septic mice, MDSCs were injected into the peritoneal cavities of mice after CLP. Results MDSCs accumulated in spleens of septic mice progressively. MDSCs could increase anti-inflammatory cytokine production, decrease the level of inflammatory factors, and improve the survival rate of mice with sepsis. Conclusion MDSCs can attenuate the inflammation and improve the survival rate of mice with sepsis, suggesting that intraperitoneal injection of MDSCs may provide a new direction for the treatment of sepsis.

Objective To investigate the role of miR-155 in diabetic nephropathy(DN)and its mecha-nism. Methods MiR-155 expression level in kidney was detected by real-time PCR and in situ hybridization. The target gene of miR-155 was predicted by bioinformatics and verified by Western Blot and double luciferase reporter activity. Western Blot was used to detect the related marker proteins of mesangial cells proliferation and mesangial matrix. Results (1)The expression of miR-155 increased in DN renal tissue and high glucose-stimulated renal cells.(2)MiR-155 was related to the regulation of Smad5 gene expression.(3)MiR-155 promoted the mesangial cells proliferation and increased extracellular matrix by down-regulating Smad5 expression. Conclusions MiR-155 can promote the mesangial cells proliferation and renal fibrosis by regulating Smad5 gene,providing a basis for further understanding the pathogenesis of DN.

ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.