Objective To determine the diagnostic significance of serum Cystatin C (Cys C),neutrophil gelatinase-associated lipocalin (sNGAL),urinary kidney injury molecule1 (uKIM-1) and urinary interleukin-18 (uIL-18) in patients with septic acute renal injury.Methods A total of 62 adult patients with sepsis admitted to the Intensive Care Unit over 24 hours in the Tianjin Hospital between August 2012 and March 2013 were divided into acute renal injury group (n =39) and non-acute renal injury group (n =23) according RIFLE diagnostic criteria.Measurements of Cys C,sNGAL,uKIM-1 and uIL-18 were performed.The diagnostic values of the biomarkers were assessed by comparing their levels between the patients of different groups.Results The levels of Cys C (2.27 ± 0.93) μg/L,sNGAL (275.04 ±79.37) μg/L,uKIM-1 (2.52 ± 1.06) μg/L in acute renal injury group were higher than Cys C (1.19 ± 0.77) μg/L,sNGAL (137.51 ± 99.33) μg/L,uKIM-1 (1.27 ± 0.62) μg/L in non-acute renal injury group (P ＜ 0.05).There was no significant difference in uIL-18 between the acute renal injury group (374.87 ± 70.23) ng/L and the non-acute renal injury group (354.09 ± 66.42) ng/L (P ＞ 0.05).The area under ROC curve for diagnostic values of serum Cystatin C,sNGAL and uKIM-1 in acute renal injury were0.84 (0.74-0.95),0.90 (0.79-1.00),0.87 (0.78-0.96).Conclusions CysC,sNGAL and UKIM-1 might be valid as diagnostic biomarkers of septic acute renal injury.

Clinical engineering is at a strategic developing point. Technical, economical, and cultural dynamics are at work shaping the future of clinical engineering. As the nature of clinical engineering transformed by these forces, delay or failure to adopt effective methods will result in a diminished role for clinical engineering in healthcare. This article will demonstrates in detail the challenges which the clinical engineering encounters presently and its direction of development in the future.

Objective To analyze the clinical features,auxiliary examination,diagnosis and treatment of pituitary abscess.Methods A retrospective analysis was done in 7 cases of pituitary abscess.All cases’ final diagnose were confirmed by histopathological results.Results 1.Four cases were diagnosed as primary pituitary abscess,the others 3 cases as secondary pituitary abscess which was associated with pituitary adenoma,pituitary cyst,craniopharyngeal duct tumor respectively.2.Clinical features:Of 7 cases,fever was determined in 6 cases,visual disturbance or temporal hemianopia in 5 cases,headache associated with anorexia and nausea and vomitting in 4 cases.High white blood cell counts was present in 3 cases,high PRL levels in 4 cases.Three cases were associated with hypothyroidism,2 cases with hypoadrenocorticism.MR image showed isointense or hypointense signal on T1WI and isointense or hyperintense signal on T2WI in pituitary abscess.Postcontrast T1WI showed a ring-shaped enhancement.Two cases were diagnosed by MR images and clinical features before surgery,the others by surgical histopathology.3.Treatment:All cases were treated with surgery,followed by antibiotics therapy.After operation all symptoms were improved except for optic nerve function.Conclusion It is suggestive of pituitary abscess when any patient present firstly with fever,headache,visual or eyeshot disturbance,partial or whole hypopituitarism associated with saddle area mass.Earlier diagnosis,timely surgery and postoperative proper antibiotics therapy are the keys to the treatment of pituitary abscess.

Objective To investigate the expression of macrophage migration inhibitory factor (MIF) in serum and renal tissue of septic rats with actue kidney injury (AKI), and to explore the effect of Chinese traditional medicine-Xuebijing injection on MIF expression as well as on acute kidney injury in rats with sepsis. Methods Sepsis model was reproduced in rats with cecal ligation and puncture (CLP).Eighty healthy SD rats were randomly divided into three groups:sham operation group(n=16), CLP model group (n=32), and xuebijing group(n=32). All rats were sacrificed at either 2, or 8, or 24 and or 48 hours after operations.MIF mRNA levels in renal tissues of septic rats were semi-quantified by Real-time PCR.The content of MIF in serum was determined by enzyme linked immunosorbent assay (ELISA). Serum creatinine (Cr) contents were measured by automatic biochemistry analyze. Results Compared with sham operation group, transcription of MIF mRNA in renal tissues of model group were significantly enhanced at 8, 24 and 48 hours after operations (P<0.01). Both contents of MIF and creatinine level in serum of model group rose obviously at 24 and 48 hours after operation (P<0.01);Compared with model group, the transcription of MIF mRNA in renal tissues of xuebijing group decrease obviously at 2, 8, 24 and 48 hours (P<0.01) and both contents of MIF and creatinine in serum of xuebijing group drop remarkably at 24 and 48 hours (P<0.01). Conclusion MIF is a kind of late cytokine which might participate in the pathogenesis of AKI in rats with sepsis.Xuebijing injection can inhibit MIF expression, and possess the protective effects on the kidney in rats with sep-sis.

Objective To explore clinical characteristics and prognostic risk factors in patients with community ac-quired pneumonia(CAP)complicated with acute kidney injury(AKI).Methods In total, 456 CAP patients were included based on the diagnostic guide.According to whether the patients were accompanied with AKI,the patients were divided in-to two groups(non-AKI group and AKI group). AKI group were further divided into risk group, injury group and failure group by RIFLE criteria using admission creatinine.Severity in CAP patients,clinical indexes and prognostic evaluation in-dexes were compared between different groups. Multiple factors were analyzed using Logistic regression model,survival analysis were examined by Kaplan-Meier, which analyzed the risk factors of poor prognosis in CAP patients and the role of RIFLE criteria in prognostic evaluation. Results Thirty percent(135)of the total 456 CAP patients were accompanied with AKI. Patients in AKI group were further divided into risked group (45.2%, 61 patients), injury group (17%, 23 pa-tients) and failure group (37.8%, 51 patients) according to the RIFLE diagnostic criteria using basal creatinine level. Among the 300 patients with PSI gradeⅠtoⅢ,23.3%(70)of patients developed AKI while among 156 patients who are with PSI gradeⅣor over, 65 patients (41.7%) developed AKI(P<0.01).The 30-day mortality of CAP patients accompanied with AKI were increased compared to Non-AKI group(Non-AKI:6.2%;Risk:14.8%;Injury:21.7%;Failure:45.1%).With de-teriorating in RIFLE criteria,the portion of patients who required mechanical ventilation, inotropic support(MV/IS)and re-nal replacement therapy(RRT)increased too. Logistic analysis revealed that AKI,age of 75 years or older and extra-renal or-gan failure were the risk factors of poor prognosis in patients with CAP. The rate of survivors was decreased in the CAP pa-tients accompanied with AKI compared with those who did not.Conclusion There is certain incidence of AKI to compli-cate CAP patients who will have a poor prognosis.RIFLE diagnostic criteria is a valuable tool to evaluate prognosis of CAP patients complicated with AKI.

Objective To detect the A20 gene deletion,investigate the impacts of A20 gene deletion on clinicopathological features and prognosis of DLBCL,and relationship between activation of NF-κB pathway and relative molecular pathogenesis.Methods A20 gene deletion was detected by fluorescence in situ hybridization (FISH).The expression of A20,Survivin,P65 and Ki-67 were detected by immunohistochemistry stain.Apoptosis was assayed by TUNEL.Follow-up and statistical analysis were done.Results The deletion rate of A20 gene was 21.7％.The deletion rate of A20 gene was obviously higher in ABC-like DLBCL than that in GCB-like DLBCL (30.6％ vs.8.3％,P＜0.05).It was observed that there was a negative correlation between A20 protein expression and A20 gene deletion (r=-0.259,P =0.023).The expression of P65 and Survivin protein was positively correlated with the A20 gene deletion (r=0.280,P =0.015;r =0.313,P =0.007).Apoptosis rate was significantly reduced in DLBCL patients with A20 gene deletion.The apoptosis rate was higher in cases with positive expression of A20 protein,while that was lower in cases with positive expression of p65 and Survivin protein than those with negative expression of corresponding protein.There was no statistically significant difference in apoptosis rate between ABC-like and GCB-like DLBCL patients (P＞0.05).COX regression analysis indicated that age,A20 gene deletion,types of DLBCL and Ki67 expression were independent factors associated with survival status.Log-rank test showed that there was a statistical difference in survival status between the cases with and without A20 gene deletion (P=0.015).Conclusion A20 gene deletion may associate with the attenuation of A20 protein expression.The latter weakens negative feedback regulation of A20 protein for NF-κB pathway.An up-regulated expression of Survivin and abnormal proliferation and apoptosis may be result from the abnormal activation of NF-κB.A20 gene deletion brings certain influence on clinical course and prognosis of DLBCL.

Diabetes is a chronic noncommunicable disease,which is can't be cured,and only can be suppressed by long-term treatment and self-management.The clinical decision support system can simulate the thinking process of diabetes specialists in disease diagnosis,and can provide the regular medical treatment plans and recommend the optimal plans to doctors.Most of the existing clinical decision support systems are based on clinical guidelines,rule-based and case-based reasoning as well as ontology-based systems.The big data technology can acquire and process multiple heterogeneous data,and provide a more scientific personalized treatment plan.In recent years,a variety of big date processing methods have been applied to the clinical diagnosis of diabetes based on decision tree,neural network,fuzzy logic,support vector machine,APRIORI association rules and multidimensional analysis,and timing mining.However,these methods are still in preliminary stage.The framework of diabetes clinical decision support system based on big data technology was analyzed,and the future diagnostic and treatment methods were forecast.

Objective Toinvestigatetheentropyoflocalfieldpotentials(LFPs)recordedinratmedialprefrontal cortex during a Y-maze working memory (WM) task, to provide computing support for neural coding mechanism.Methods Sixteen-channel LFPs were recorded from SD rats while they performed a Y-maze WM task.The data came from 4 rats, 20 trials (10 correct trials and 10 incorrect trials) per rat provided by laboratory of neurobiology in medicine,Tianjin Medical University.Original LFPs were preprocessed to remove 50 Hz power line noise and baseline drift.Multi-taper Fourier transform was applied to calculate spatial distributions of LFPs and band pass filter were used to extract characteristic signal.The entroy coding of 16 channel LFPs was as follows: the physiological window was set to be 500 ms, the step length of physiological window was set to be 125 ms, windows were added to LFPs data, and then LFPs entropy of each sliding window was computed and averaged to get the trend of multichannel entropy values duringthe WM task.Results The power of θ band (4-12 Hz) in LFPs increased.The averaged entropy value ofmultichannel θ band LFPs in correct trials was 0.939±-0.020, which were larger than those in the resting state, 0.795±0.031 (P＜0.05).Those during wrong WM task had no significant difference, which didn't encode the WM task.Conclusions The principal frequency band related to WM is the θ band and LFPs entropy encodes the WM effectively.

Objective To systematically evaluate the clinical effectiveness and safety of Breviscapine injection combined with conventional therapy in the treatment of unstable angina pectoris (UAP).Methods The literature were systematicly retrieved about the randomized controlled trials (RCTs) of Breviscapine injection for UAP. The Cochrane Risk of Bias Assessment Table was used to evaluate the methodological quality of the RCTs and then the data were extracted and meta-analysed by RevMan 5.3 software.Results A total of 15 RCTs with 1202 participants were included. In the meta-analysis, the combination of Breviscapine injection and conventional therapy in the treatment of UAP can achieve better angina pectoris curative effect (Z=7.74,P<0.01), theRR(95% CI) was 1.23 (1.17,1.30), and the electrocardiogram curative effect (Z=6.26,P<0.01), the RR(95% CI) was 1.32(1.21, 1.44). Furthermore, Breviscapine injection can improve hemorheologic parameters. And there was no major or serious adverse drug event.Conclusions The Breviscapine injection combined with conventional therapy shows good therapeutic effect on UAP.