Acute kidney injury (AKI) is the most common and serious complication in the intensive care unit.The mortality of AKI is still as high as 60％ in critically ill children because of lack sensitive and special early predictive biomarker.Neutrophil gelatinase-associated lipocalin is one of the most promising early diagnose and predict biomarkers for AKI,produced and secreted by kidney tubule cells at low levels,but increasing dramatically in the urine and serum after ischemic, sepsis, or nephrotoxic injury of the kidneys.This review is to summarize the role of neutrophil gelatinase-associated lipocalin as an early biomarker of AKI with different clinical settings in children.

Diffuse large B-cell lymphoma (DLBCL) is the aggressive non-Hodgkin's lymphoma.Rituximab in combination with chemotherapy had improved the outcomes,however,a substantial proportion of these patients transfer into refractory or eventually relapsed lymphoma after using R-CHOP as a front-line treatment regimen with poor prognosis.With the research development on DLBCL and its related gene,it is confirmed that gene biological targeted therapy can improve the prognosis of patients with refractory /relapsed DLBCL (RR-DLBCL).Recently,some new targeted therapies become research hotspots.This review will focus on recent development and future direction of biological targeted treatment in RR-DLBCL.

Objective To investigate the effects of different flow volume of continuous 1:1 blood crystalloid cardioplegia on open heart surgery.Methods Retrospective randomized study was performed on 80 patients undergoing valve replacement and congenital heart disease with 1:1 blood crystalloid cardioplegia by minimum-flow continuous perfusion[0.5ml/(kg·min),group A,40 cases],high-flow continuous perfusion[(2.0 ml/(kg·min),group B,40 cases).The changes of creatine kinase(CK),isoenzyme of creatine kinase(CK-MB),lactate dehydrogenase(LDH),lactic dehydrogenase isoenzyme(LDH_1)were detected before operation and at 6,12,24,48,72 h after operation.Results The cardioplegia liquid was (41.72±7.98)ml/kg in group A,(142.09±9.65)ml/kg in group B,there was significant difference between two groups(P<0.05).During the first 72 h postoperative the value of CK,CK-MB,LDH and LDH1 in two groups were increased to different degree,serum enzymes levd increased significantly between 12,24 h after operation(P<0.05)and return to normal at 72h after operation in two groups.Butbetween two groups there was no significant difference(P＞0.05).ConclusionMinimum-flow continuous perfusion of 1:1 blood crystalloid cardioplegia appears to be superior in safety,decrease of myocardial enzymes integrity.

Objective To explore the effect of cognitive therapy on patients with traumatic paraplegia.Methods Toally 100 traumatic paraplegia patients were randomly divided into observation group and control group with 50 cases in each.The control group received routine nursing intervention and the observation group cognitive therapy on the basis of intervention for the control group.The two groups were compared in terms of anxiety,depression,mental health,suicidal ideation and quality of life by the instruments of self-rating anxiety scale (SAS),self-rating depression scale (SDS) and suicide attitude questionnaire (SQA) before and after intervention.Results Before the intervention,the scores by SDS,SAS scores and SQA were insignificant different between the groups (P＞0.05).Mter the intervention,the scores on suicidal ideation in the observation group were significantly higher and the quality of life were significantly higher and the depresion and anxiety and the mental health status were lower than those of the control group (P ＜0.05).Conclusion The cognitive therapy for the patients with traumatic paraplegia can significantly alleviate their depression and anxiety,reduce their suicidal ideation and improve the quality of life.

Objective To investigate the influence of inspired oxygen fraction (FiO2) on the ratio of PaO2/FiO2(P/F) during the implementation of lung protective ventilation strategy in patients with acute respiratory distress syndrome(ARDS) in order to unravel its clinical significance. Method This was a prospective study of 16 selected patients with ARDS treated with mechanical ventilation ( MV ) to get ratio of P/F in range of 100 to 200 by PEEP≥5 cmH2O and high inspired oxygen. After lung recruitment maneuvers by BiPAP with high pressure (PH) of 40 cmH2O for40 s, the MV was maintained the basic requirement for stabilizing the patients for 30 minutes. A series of FiO2 were set at fractions of 0.5,0.6,0.7,0.8,0.9 and 1in random sequence, and the changes of respiratory mechanics, blood gas and hemodynamics under the different concentrations of FiO2 were analyzed by using SPSS version 13.0 software. Results ( 1 ) The ratio of P/F increased as FiO2 increased, and it's significant as FiO2 increased to 0.7 or above. As the fractions of FiO2 were set at 0.5 and 1. O, the ratios of P/F changed in 24.70% ± 23.36% respectively. ( 2 ) Of them,6 patients ( 37.5% ) treated with FiO2 set at 0.5 had the ratio of P/F ＜ 200, and the fraction of FiO2 was increased to 1.0, the P/F ＞ 200. (3) FiO2 and Qs/Qt were negatively correlated ( r = - 0.390, P = O. 027 ),the higher inspired oxygen fraction, the lower shunt. When the fractions of FiO2 were set at 0.5 and 1.0 ,there was a positive correlation between △Qs/Qt and △P/F( r = 0.82, P = 0.005 ). Conclusions The inspired oxygen fraction affects the ratio of P/F, which may be resulted from shunt and it may influence the diagnosis of ARDS.

PTEN is a dual protein/lipid phosphatase.As a negative regulator of PI3K/Akt pathway,PTEN not only plays an important role in multiple cellular functions such as cell metabolism,proliferation,cell-cycle progression,but also modulates angiogenesis via down-regulating PI3K-Akt-VEGF-HIF pathway in many tumors.In this review,the recent studies on the roles and mechanisms of PTEN in regulating tumorigenesis and angiogenesis are discussed to explore PTEN as a favorable prospect target in the treatment of angiogenesis.

Objective To investigate the influence of the establishment of Chest Pain Center (CPC) on the reperfusion treatment and prognosis of patients with acute ST segment elevated myocardial infarction (STEMI).Methods One hundred and eighteen patients with acute STEMI admitted into the Department of Emergency in Weifang People's Hospital from March to May 2016 before the establishment of the CPC were assigned as a control group,and 112 patients with STEMI admitted from September to November 2016 after the establishment of CPC were assigned as a study group.The first electrocardiograph (ECG) of all emergency patients was finished by nurses in the control group,after the cardiology physicians of Emergency Department having examined the patients,those with definite diagnosis of acute STEMI were sent into a resuscitation room immediately,and a loading dose of aspirin 300 mg and ticagrel 180 mg were given orally to each of the patients.The patients who accepted the primary percutaneous coronary intervention (PPCI) were transferred into a catheterization room as soon as possible;the patients who could not accept the PPCI,after the exclusion of contraindications of thrombolysis,were transferred into the emergency intensive care unit (EICU) to receive the intravenous thrombolytic treatment.For the study group,a uniform training was implemented,including the ECG interpretation,the diagnosis and treatment processes of chest pain for all of the medical staff,and establishment of a CPC database.The patients who were diagnosed as acute STEMI entered into the green channel of chest pain.For the patients who accepted the PPCI,the catheterization room was started immediately.The patients who could not accept the PPCI received the intravenous thrombolysis treatment:intravenous drip of urokinase 1 500 kU dissolved in 100 mL physiological saline was finished in 30 minutes.After treatment,the differences in the time from symptom onset to first medical contact (SO-to-FMC),the finished time of the first ECG after admission,the time of visiting doctor to reperfusion treatment[beginning of thrombolysis or ballon dilatation (DTRT)] including the door-to-needle (D2N) time or the doorto-balloon (D2B) time,the incidence of heart failure during hospitalization,the left ventricular ejection fraction (LVEF) measured with color Doppler ultrasound on the 7th day after admission and the in-hospital mortality were compared between the two groups of patients.Results There was no statistically significant difference between the study and control groups in the SO-to-FMC time (minutes:140.3 ± 108.4 vs.139.4 ± 112.7,P ＞ 0.05).The finished time of the first ECG after admission in the study group was significantly shorter than that of the control group (minutes:7.7 ± 1.3 vs.8.9 ± 1.7,P ＜ 0.05),the door to reperfusion time in the study group was also significantly shorter than that of the control group [D2B (minutes):72 ± 13 vs.83 ± 17,D2N (minutes):27 ± 9 vs.33 ± 12,both P ＜ 0.01].The incidence of heart failure during hospitalization of the study group was significantly lower than that of the control group [40.2％ (45/112) vs.53.4％ (63/11 8)].The left ventricular ejection fraction (LVEF) measured at one week after admission in study group was significantly higher than that of the control group (0.54 ± 0.05 vs.0.53 ± 0.04,P ＜ 0.01).The in-hospital mortality of the study group was lower than that of the control group [9.8％ (11/112) vs.14.4％ (17/118)],but there was no statistically significant difference between the two groups (P ＞ 0.05).Conclusion The application of the CPC run mode can further elevate the therapeutic level of reperfusion therapy,shorten the total ischemic time and improve the prognosis of patients with STEMI.

Objective To explore CT findings of pulmonary non‐tuberculosis mycobacteria (NTM ) disease .Methods Forty‐two patients with pulmonary NTM disease confirmed by the biphasic medium flora identification (NTM group) ,and 60 patients with lung tuberculosis (TB group) confirmed by the tubercle bacillus cultivation and flora identification in our hospital were included in the ret‐rospective analysis .9 CT signs and distribution features of the lesions were analyzed and compared between the two groups .The difference was statistically significant if P<0 .05 .Results Pulmonary NTM disease was more common in female patients (χ2=5 .500 ,P=0 .019) ,and the mean age was significantly older than that of the tuberculosis (t=3 .456 ,P=0 .001) .The detection rate in the right middle lobe and left tongue section was high in NTM group than in TB group (χ2 =8 .361 ,P=0 .004) .Logistic regression showed that bronchiectasis and bronchial stenosis or occlusion were independent risk factors for the NTM disease .They were important signs for the differential diagnosis from tuberculosis .Conclusion MSCT findings of pulmonary NTM disease have certain characteristic , which are helpful for the diagnosis .

Atherosclerosis is the pathological basis of ischemic stroke. Peripheral blood leukocytes are involved in the occurrence and progression of atherosclerosis and cause vascular endothelial injury. A series of changes of peripheral immune cel take place after acute ischemic stroke and cause inflammatory cel infiltrating into the brain tissue. The elevated leukocyte count is closely associated with the occurrence and prognosis of coronary atherosclerotic heart disease. Studies have also shown that the elevated leukocyte count may influence the occurrence of ischemic stroke, neurological deficit, recurrence, and death. This article reviews the relationship between peripheral blood leukocytes and ischemic stroke.

Hypoglycemia is a common metabolic problem in newborn infants,which might lead to brain injury even brain death when it keeps extremely low for a long time.Therefore,it is of great importance to monitor blood glucose in neonates,especially in groups of infants who are at risk of hypoglycemia,in order to identify and treat this condition and prevent adverse neurological outcomes promptly.It is given that infant of a diabetic mother,preterm neonate,low birth weight and asphyxia are its risk factors.Relative to blood glucose monitoring methods in clinical,continuous glucose monitoring system is comprehensive,continuous and with low pain.Continuous glucose monitoring system has been applied in high-risk neonates of hypoglycemia in recent years.It is of great help to understand the complete picture and change trend of blood glucose,optimize blood glucose management,study newborn glucose metabolic characteristics and the relationship between hypoglycemia and brain damage,so as to define and manage neonatal hypoglycemia.