Acute kidney injury (AKI) is a serious clinical problem with high morbidity and mortality. Renal replacement therapy (RRT) is an important tool for treating patients with AKI. The 2011 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI points out that RRT should be discontinued when renal function has recovered enough to meet the body needs or when RRT is no longer consistent with treatment goals. However, the specific reference index of weaning RRT is unclear. The guiding roles of traditional indicators such as urine output (> 400 mL/24 h), serum creatinine (SCr, decreasing trend), creatinine clearance (CCr, > 20 mL/min), and novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), hepatocyte growth factor (HGF), interleukins (IL-6, IL-10), kidney injury molecule-1 (KIM-1), kynurenic acid, etc. for discontinuation of RRT in AKI patients were reviewed. Particularly, the importance of biomarkers for this purpose was highlighted.

Objective To investigate effects of isoflurane anesthesia of different time interval on acute injury of brain function in neonatal rats with consistent total time of isoflurane anesthesia. Methods Seven-day neonatal Sprague-Dawley (SD) rats were randomly divided into normal control group (breathe the air), continuous anesthesia group (a single 6-hour exposure to 1.5% isoflurane), and intermittent anesthesia 1 day and 3 days groups (three times of 2-hour exposure to anesthesia with an interval of 1 day or 3 days), 12 rats in each group. The ratio of male to female was 5:7. They underwent the test of learning and memory in the radial arm maze (RAM) 21 days after birth, twice a day for 4 days. The number of entry into wrong arms, number of repeated errors, number of total arm entries, and time for completing the task were recorded for evaluation of effect of neonatal isoflurane on cognitive behavior in rats. Results ① Compared with normal control group, the percentage of number of errors > 3 in anesthesia of 3-day interval group was significantly decreased (33.3% vs. 46.9%, P < 0.05), the percentages of repeated errors > 0 and total arm entries > 8 were significantly increased (33.3% vs. 18.8%, 27.1% vs. 13.5%, both P < 0.05), but there were no statistically significant difference in the percentage of mistake number > 3 between continuous anesthesia group, interval anesthesia 1-day group and the normal control group (44.8%, 44.8% vs. 46.9%), the percentages of number of repeated mistake > 0 and total arm entries > 8 in above three groups were slightly increased as compared with those of normal control group (27.1%, 22.9% vs. 18.8%, 20.8%, 21.9% vs. 13.5%, all P > 0.05). No statistical differences in completing the task among normal control group, continuous anesthesia group, interval anesthesia 1 day and 3 days groups were found (minutes: 1.32±0.91, 1.54±1.05, 1.46±0.86, 1.38±0.79, all P > 0.05). ② It was found by gender analysis that the percentages number of repeated errors > 0 and total arm entries > 8 were significantly lower in female rats than those in the male rats only in normal control group (5.0% vs. 28.6%, P < 0.01; 5.0% vs. 19.6%, P < 0.05). There was no obvious gender difference in exposed groups. ③ Compared between groups of female rats, the percentages of repeated mistake > 0 in continuous anesthesia group, interval anesthesia 1 day and 3 days groups (25.0%, 25.0%, 30.0% vs. 5.0%, P < 0.05 or P < 0.01) and the percentage of total arm entries > 8 in interval anesthesia 1 day and 3 days groups were significantly higher than that of normal control group (22.5%, 25.0% vs. 5.0%, both P < 0.05). No significant difference about the RAM task in male rats of all the four groups was found. Conclusions Different time interval of neonatal isoflurane exposure may develop certain degree of acute brain injury in rats, characterized by cognitive function. Prolongation of the interval time significantly enhanced long-term memory in rats. Multiple neonatal exposures to isoflurane were associated with greater cognitive impairment than a single exposure. In addition, isoflurane can significantly increase cognitional functional disorder in the female, not in the male rats.

Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.

Objective To study the change in endogenous hydrogen sulfide (H2S) in patients with acute pancreatitis and its relationship to coagulation function. Methods A prospective case control study was conducted. Forty patients with mild acute pancreatitis (MAP group) and 40 with severe acute pancreatitis (SAP group) admitted to Yiwu Central Hospital in Zhejiang Province from December 2002 to March 2015 were enrolled. Forty healthy persons served as control (healthy control group). Blood was collected to determine the levels of H2S, blood coagulation factor Ⅷ (FⅧ), von Willebrand factor (vWF), plasminogen (PLG), antithrombin (AT), platelet count (PLT), tissue factor (TF), tumor necrosis factor-α (TNF-α), and protease activated receptor-1 (PAR-1). The correlations among the above parameters were analyzed. Results There was no statistical significance in sex, age, body weight and time of disease among three groups, indicating it was comparable among the groups. Compared with healthy control group, the levels of H2S, FⅧ, vWF, TF, TNF-α, and PAR-1 in MAP and SAP groups were significantly elevated [H2S (μmol/L): 67.42±6.34, 112.47±12.69 vs. 42.57±4.18, FⅧ: (67.5±5.8)%, (82.3±4.7)% vs. (57.2±6.4)%, vWF: (112.6±9.7)%, (142.5±12.5)% vs. (76.4±8.2)%, TF (ng/L): 45.27±4.34, 64.76±6.25 vs. 18.15±1.89, TNF-α (ng/L): 197.67±13.62, 324.72±25.54 vs. 20.08±2.57, PAR-1 (fluorescence intensity): 32.16±4.43, 56.12±7.07 vs. 12.27±2.12, all P < 0.01], and PLG and AT activity were significantly decreased [PLG: (52.4±4.7)%, (36.7±3.2)% vs. (62.1±5.6)%, AT: (43.2±6.9)%, (35.5±5.4)% vs. (53.6±6.1)%, all P < 0.01]. The changes in the parameters in SAP group were more remarkable than those in MAP group (all P < 0.01). PLT in SAP group was significantly lower than that in healthy control and MAP groups (×109/L: 8.5±1.1 vs. 15.7±2.8, 12.4±1.9, both P < 0.01). H2S was positively correlated with FⅧ, vWF, TF, TNF-α, and PAR-1 (r value was 0.56, 0.61, 0.72, 0.66, 0.64, respectively, all P < 0.01), and it was negatively correlated with PLG and AT (r value was -0.64, -0.57, both P < 0.01). Conclusion As an inflammatory factor, endogenous H2S deteriorates coagulation function in patients with acute pancreatitis by up-regulating TF, TNF-α, and PAR-1.

Objective To collect the main contents of research in critical care medicine in foreign countries with the purpose of providing references for domestic research. Methods A two-way clustering analysis of foreign literature in PubMed concerning critical care medicine was conducted from 2004 to 2015 in this study, and the subjects of greatest interest were collected through the information visualization analysis pathway. Results Eight areas of most popular interest critical care medicine from January 1st, 2004 to November 8th, 2015 were found: blood sugar control in intensive care unit (ICU), acute kidney injury (AKI) and renal replacement therapy (RRT), nutritional support, the impact of ICU practice on reducing mortality, the assessment of critical patients, study of antibiotic resistance, the assessment of the life quality of critically ill patients, and home care and the rehabilitation of critically ill patients. According to the related literature, research in the field of critical care medicine has been growing steadily. USA, Japan, and Europe are the most developed countries or area in the field of critical care medicine. The four major research networks concerning research in critical care medicine were found: the control of blood glucose, monitor of circulatory function, nutritional support, and studies on AKI. Conclusion The most popular topics in research concerning critical care medicine research from 2004 to 2015 were blood glucose control, monitoring of circulatory function, nutritional support and AKI.

Acute kidney injury (AKI) is one of the most common serious complications in critically ill patients, and it is an independent risk factor for death. In recent years, renal replacement therapy (RRT) has become one of the routine treatments for AKI patients, however there is no accepted consensus on the optimal timing of RRT over the world. This paper reviewed the clinical studies carried out by researchers in the field of critical care and nephrology, thereby summarized and analyzed the related parameters of the optimal time to carry out, with the exception of previously acknowledged classic RRT indications such as hyperkalemia, severe metabolic acidosis, volume overload and so on. The feasible parameters such as serum creatinine (SCr), blood urea nitrogen (BUN), urine volume, the time admitted in the intensive care unit (ICU) and several standards distinguished AKI stages are discussed in order to find out the cutoff points of those parameters which were best for the patients' outcome, and to provide guidance of decision making for the optimal timing of RRT for AKI patients.

Objective To compare the clinical effects between continuous renal replacement therapy (CRRT) and intermittent haemodialysis (IHD) for the treatment of sepsis-induced acute kidney injury (AKI). Methods A prospective study was conducted. Seventy-three patients with sepsis-induced AKI admitted to the intensive care units (ICUs) of Tianjin Hospital and Tianjin First Center Hospital from January to December in 2014 were enrolled. They were randomly divided into two groups: CRRT group (n = 35) and IHD group (n = 38). Data were recorded for the patients in two groups before treatment, including acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mean arterial pressure (MAP), urine volume, and the levels of C-reactive protein (CRP) and serum creatinine (SCr) before and 1 week after treatment, the time of recovery of urine volume, the length of ICU stay, the duration of organ support, and the incidence of cardiovascular events. Results There was no statistically significant difference in APACHE Ⅱ scores (21.63±2.46 vs. 21.34±2.46), MAP [mmHg (1 mmHg = 0.133 kPa): 71.26±10.70 vs. 75.74±15.17], urine volume (mL: 404.00±79.13 vs. 438.97±87.17), CRP (mg/L: 100.94±14.73 vs. 95.17±27.03), and SCr (μmol/L: 394.02± 50.26 vs. 390.47±54.42) before treatment between CRRT group and IHD group (all P > 0.05). One week after treatment, compared to the IHD group, CRRT could dramatically reduce the levels of CRP (mg/L: 41.05±10.15 vs. 60.21±14.78, t = 6.401, P < 0.001), SCr (μmol/L: 185.97±65.48 vs. 232.02±71.93, t = 2.862, P = 0.006), urine output recovery time (days: 7.94±3.06 vs. 11.08±3.71, t = 3.923, P < 0.001), the length of ICU stay (days: 9.54±3.39 vs. 13.42±3.89, t = 4.521, P < 0.001), organ support time (days: 3.23±2.70 vs. 6.34±3.36, t = 4.343, P < 0.001), and the incidence of cardiovascular events [23.53% (8/35) vs. 39.47% (15/38), χ2 = 5.509, P = 0.025]. Conclusion Compared to IHD, CRRT can more efficiently help patients with sepsis-induced AKI in removing excessive water, metabolic waste, and lower the levels of pro-inflammatory cytokines, maintain homeostasis of the internal environment, lower the adverse effects on cardiovascular system, so that it significantly improve the prognosis of patients, shorten the time of organ support and the length of ICU stay.

Objective To investigate the clinical significance of serum microRNA-151a-3p (miR-151a-3p) expression in peripheral blood of patients with acute cerebral infarction (ACI), and to analyze the correlation between miR-151a-3p and related inflammatory factors, in order to obtain new evidence and ideas in the diagnosis and treatment of ACI. Methods A retrospective analysis was conducted. The clinical data of patients with ACI admitted to Department of Neurology of People's Hospital of Wuhan University from April to July in 2004 were enrolled. 114 ACI patients with first onset and duration of 2-14 days served as the research objects, and in the same period 58 healthy persons with matched age, and gender served as healthy control group. The risk factors of cerebral infarction in ACI patients and levels of serum miR-151a-3p, interleukins (IL-6, IL-8), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) in all the subjects were completely recorded. The correlation between serum miR-151a-3p and the area and type of cerebral infarction, the causes of infarction as well as the inflammatory cytokines was analyzed. The correlation of 10-year survival rate of patients with different expression levels of miR-151a-3p in patients with ACI was analyzed. Results A total of 114 patients with ACI were enrolled, with 59 male, 55 female, and age ranged 48-63 years with a mean of (55.0±6.7) years. Large infarction was found in 25 cases, middle sized infarction in 26 cases, small infarction in 53 cases, and lacunar infarction in 10 cases. According to the modified Trial of Org 10172 in acute stroke treatment (TOAST), the patients were classified as thrombotic cerebral infarction (AT) 92 cases, embolism (CE) from cardiac origin 10 cases, and small arterial occlusive cerebral infarction (SAD) 12 cases. After eliminating the influence of cerebral infarction risk factors on the expression level of miRNAs, and compared with that of healthy control group, the level of serum miR-151a-3p expression was significantly increased in ACI group (2-ΔΔCt: 2.28±1.85 vs. 1.27±0.98, P < 0.01); the levels of serum miR-151a-3p in large, middle, small, lacunar infarction groups were markedly up-regulated (2-ΔΔCt: 1.78±1.02, 1.92±1.11, 2.22±1.54, 2.61±1.82 vs. 1.27±0.98, all P < 0.05) with no significant difference among different infarction groups. The serum miR-151a-3p expression in AT and CE groups was significantly higher than that of the healthy control group (2-ΔΔCt: 2.01±1.45, 1.99±0.89 vs. 1.27±0.98, both P < 0.05), but no significant difference was found between SAD group and healthy control group (2-ΔΔCt: 1.72±0.30 vs. 1.27±0.98, P > 0.05). The levels of serum IL-6, IL-8, CRP and TNF-α in ACI group were all higher than those of healthy control group [IL-6 (ng/L): 45.21±14.33 vs. 39.70±13.15, IL-8 (μg/L): 29.12±14.92 vs. 22.50±10.12, CRP (mg/L): 6.61±3.02 vs. 5.40±2.75, TNF-α (ng/L): 65.20±16.14 vs. 55.70±14.35, all P < 0.05]. In addition, higher expression of serum pro-inflammatory mediators IL-6, IL-8, CRP and TNF-α were positively correlated with miR-151a-3p (R2 value were 0.092, 0.055, 0.034, 0.036, all P < 0.05). Ten-year survival rate was higher in patients with low expression of miR-151a-3p [with 1.27±1.98 as the boundary, 48.57% (17/35) vs. 34.18% (27/79), log-rank = 3.411, P = 0.045]. Conclusions Up-regulated serum miR-151a-3p may be involved in the pathophysiology of ACI. Therefore, miR-151a-3p may be used as a reference to predict the severity of neurological deficit in clinic.

Objective To investigate the effect of necrostatin-1 (Nec-1) on the expression of liver monocyte chemotactic protein-1 (MCP-1) in septic rats and its mechanism. Methods Forty-eight male Sprague-Dawley (SD) rats were randomly divided into sham group, model group, and Nec-1 group by randomized digital number method, with 16 rats in each group. The model of sepsis was reproduced by cecal ligation and puncture (CLP). Rats in sham group received anesthesia, and flipping the cecum followed by closure of the abdomen without ligation of the cecum. Rats in Nec-1 group were given 1 mg/kg Nec-1 [25 mg Nec-1 solution dissolved in 2.5 mL of dimethyl sulfoxide (DMSO)] through caudal vein 30 minutes before operation, while the rats in model group were given 0.1 mL/kg of DMSO only. Blood from abdominal aorta and liver tissue in each group were collected at 0 hour and 8 hours after operation. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined with automatic biochemistry analyzer. The pathological changes in liver were observed under light microscope using hematoxylin-eosin (HE) staining. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme linked immunosorbent assay (ELISA). The MCP-1 mRNA expression in the liver was determined by reverse transcription-polymerase chain reaction (RT-PCR). Results There was no significant differences in the levels of serum ALT, AST, TNF-α, IL-6 and expressions of liver MCP-1 mRNA at 0 hour among three groups, and the liver cellular structure was normal. At 8 hours, compared with sham group, the expressions of serum ALT, AST, TNF-α, IL-6 and liver MCP-1 mRNA were significantly increased in model group and Nec-1 group [ALT (U/L): 172.35±21.88, 129.67±18.20 vs. 60.04±11.74, AST (U/L): 511.03±34.92, 363.51±25.25 vs. 254.83±31.04, TNF-α(ng/L): 603.96±24.18, 483.87±26.60 vs. 265.74±15.14, IL-6 (ng/L): 975.62±65.37, 712.09±45.47 vs. 310.42±13.88, MCP-1 mRNA (2-ΔΔCt): 7.09±0.18, 5.51±0.45 vs. 0.99±0.06, all P < 0.05]. Levels of the above parameters in Nec-1 group at 8 hours were significantly decreased compared with those of model group (all P < 0.05). Under light microscopy, it was noted that the structure of hepatic lobules was destroyed, with exacerbation of immunocyte infiltration at 8 hours in model group. At 8 hours, it was found that Nec-1 alleviated the pathological damage in Nec-1 group. Conclusion Nec-1 can protect the liver of rats with sepsis, lower the expression of serum TNF-α and serum IL-6 and liver MCP-1 mRNA, and obviously reduce the damage of inflammation.

Objective To evaluate the therapeutic value of alpha-fetoprotein (AFP) and cholinesterase (ChE) in patients with hepatitis B virus related acute onset chronic liver failure (HBV-ACLF). Methods A case-control observation was conducted. Sixty-seven patients with HBV-ACLF admitted to Tianjin Second People's Hospital from January 2009 to October 2015 were enrolled. According to the diagnostic criteria of ACLF, the patients were divided into early, middle, and late groups, and alternatively, according to the outcome, they were divided into survival group and death group. Serum samples were collected after 0, 2, 4, 8 weeks to determine the value of AFP and ChE and analyze the value of AFP and ChE in reflecting the changes during HBV-ACLF progression. The differences in AFP and ChE between the survival group and the death group were compared. The prognostic values of AFP and ChE for HBV-ACLF patients were evaluated. Results Among 67 patients, there were 24, 24, and 19 patients in the early, middle and late stage, respectively, and there were 0, 9, 18 deaths at 8 week. With the advance of HBV-ACLF, the levels of both AFP and ChE were decreased in the early, middle, and late stage, with the AFP value of 40.205 (14.663, 90.550), 23.445 (8.233, 64.213), 8.990 (6.120, 14.340) μg/L (F = 36.149, P = 0.000) and the ChE value of (4.217±1.408), (3.619±1.200), (2.503±1.248) kU/L, respectively (F = 19.575, P = 0.000). In the death group, the levels of serum AFP at 0, 2, 4, 8 weeks were significantly lower than those in survival group [μg/L: 21.540 (7.670, 50.470) vs. 60.680 (16.383, 146.100), 10.560 (6.170, 20.100) vs. 60.090 (27.662, 100.700), 8.750 (3.045, 10.105) vs. 51.875 (16.778, 88.833), 3.900 (2.120, 7.660) vs. 20.400 (12.950, 50.430), P < 0.05 or P < 0.01]. The levels of serum ChE at 2, 4, 8 weeks in the death group were significantly lower than those in the survival group (kU/L: 3.206±1.480 vs. 4.008±1.227, 2.893±1.478 vs. 4.140±1.236, 2.948±1.355 vs. 4.329±1.390, P < 0.05 or P < 0.01). The levels of AFP in 67 patients were 30.100 (10.100, 90.100) μg/L, and ChE was (3.685±1.382) kU/L at 2 weeks, and they showed no correlation between AFP and ChE according to the linear correlation analysis (r = 0.082, P = 0.508), suggesting that AFP and ChE could be used as two independent prognostic factors for HBV-ACLF patients. It was showed by receiver operating characteristic curve (ROC) analysis that the area under the curve of AFP (AUC) was 0.847 (P = 0.000), while the AUC of ChE was 0.681 (P = 0.012). The highest values of Youden index and the maximum effectiveness of testing were obtained when AFP and ChE reached 20.520 μg/L and 2.924 kU/L, respectively, with the sensitivity and the specificity of AFP being 85.0% and 77.8%, respectively, and of ChE being 77.5% and 59.3%, respectively. When using the value of AFP ≥ 20.520 μg/L combined with the value of ChE ≥ 2.924 kU/L, the sensitivity for predicting HBV-ACLF outcome was 65.9%, and its specificity was 91.0%. Conclusion Both AFP and ChE were helpful in providing accurate information for the progression and prognosis of HBV-ACLF patients due to the facts that their values were less interfered by the clinical treatment and that they have higher specificity.