Acute kidney injury (AKI) is a common and serious clinical syndrome after cardiac surgery with the high morbidity and mortality.As the markers of AKI,Serum creatinine and urine output is not sensitive for early detection.Due to the lack of early biomakers for AKI,early effective treatment has been delayed.Identification of novel biomarkers for AKI has progressed to the clinical phase.Novel biomakers include neutrophil gelatinase-associated lipocalin,kidney injury molecule-1,Cystatin C,IL-18,and so on.In this article the author will review the current progress of these clinical and experimental novel AKI biomarkers.

Objective To explore the effect of curcumin on the activity and migration of as well as c-kit mRNA expression in melanocytes.Methods Human epidermal melanocytes were isolated from the prepuce in adolescents and subjected to primary culture.To estimate the effect of curcumin on the proliferative activity of melanocytes, some melanocytes were randomly divided into several groups to be cultured in the MelM-2 medium with or without the presence of 5, 10, 20 or 30 μmol/L curcumin, the MelM-2 medium containing curcumin of 5-30 μmol/L served as the drug control groups, and the MelM-2 medium without curcumin served as the blank control group.After 24 and 48 hours of culture, MTS assay was performed to evaluate the proliferative activity of melanocytes.Some cultured melanocytes were randomly divided into 4 groups to be cultured in the MelM-2 medium with 0, 5, 10 and 20 μmol/L curcumin respectively for 48hours.Then, wound scratch assay was conducted to estimate the migratory activity of melanocytes, and real-time fluorescence-based quantitative PCR to quantify the mRNA expression of c-kit in melanocytes.Statistical analysis was carried out by factorial design analysis of variance (ANOVA), one-way ANOVA and least significant difference (LSD)-t test.Results The proliferative activity of melanocytes was significantly decreased at 24 and 48 hours in the 30-μmol/L curcumin group compared with the negative control group (0.783 ± 0.053 vs.1.000 ± 0.018 at 24 hours, 0.637 ± 0.015 vs.0.993 ± 0.064 at 48 hours, both P ＜ 0.05), while no significant differences were observed between the other curcumin groups and the negative control group (all P ＞ 0.05).The 48-hour treatment with curcumin could significantly inhibit the migration of melanocytes in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (all P ＜ 0.05).The mRNA expression level of c-kit was also significantly reduced at 48 hours in the 5-, 10-and 20-μmol/L curcumin groups compared with the control group (1.799 ± 0.372, 1.539 ± 0.224 and 1.026 ± 0.038 vs.3.371 ± 0.352, all P ＜0.05).Conclusion Curcumin at low concentrations (≤ 20 μmol/L) has no obvious cytotoxicity against melanocytes, but can inhibit the migration of and c-kit mRNA expression in melanocytes, while curcumin at 30 μmol/L can promote the apoptosis of melanocytes.

Objective To explore the feasibility of laparoscopic surgery for esophageal hiatus hernia and reflux esophagitis complicated with cholecystolithiasis.Methods Five trocars were used for the patients to perform laparoscopic hiatal hernia repair,followed by fundoplication(Nissen fundoplication in 21 cases and Toupet fundoplication in 6),and then LC.Results The procedures were completed in all of the 27 cases.The postoperative mean esophageal pressure of the patients was significantly higher than that before the operations [(19.32?4.11) mm Hg vs(7.30?1.36) mm Hg,t=-16.407,P=0.000],while the 24-hour pH value were decreased markedly(9.20?2.15 vs 160.16?50.30,t=16.387,P=0.000).No hemorrhage,intra-abdominal infection,biliary leakage occurred in this series.The patients were followed up for 1 to 24 months(1-6 months in 7 cases,and 7-24 months in 20 cases),during which no esophageal stenosis or incisional hernia were detected.Conclusions It is feasible to perform primary laparoscopic surgery for patients suffering from esophageal hiatus hernia and reflux esophagitis complicated with simultaneous cholecystolithiasis,if no contraindications.

Objective To study the effect of percutaneous CT-guided lung biopsy on the patients with peripheral lung focus.Methods Percutaneous CT-guided lung biopsy was performed in 38 patients with peripheral lung focus who were admitted to the Affiliated Hospital,Armed Police Medical College from Feb.2002 to Jan.2005.Results A total of 38 patients were studied,including 30 patients with lung cancer,2 patients with pulmonary tuberculosis,5 patients with benign pulmonary diseases and 1 patient with negative result.The positive rate was 97.36% in the 38 cases with a slight side effect.Conclusion This method is simple,safe and effective,and it is very important in diagnosis of patients with peripheral lung focus.

Objective To investigate the effects of dexmedetomidine on the inflammatory response during the aortic dissection perioperative period.Methods 53 patients with the type A aortic dissection who needed surgical treatment were randomly divided into the study group and the control group.Patients in the study group (group A) received dexmedetomidine (0.2-0.7 μg · kg-1 · h-1) while patients in the control group (group B) received morphine 0.2-0.6 mg/h to ease pain after they were admitted and continued to 48 h after the operation.The serum levels of TNF-α,MMPs,NE,NT-proBNP and CRP were measured in the patients at the time enrolled taking none of the two drugs(T0),before the operation(T1),immediately after the operation (T2) and 12 h (T3),24 h (T4),48 h (T5),72 h (T6) after the operation.MODS score and the length of stay in ICU were observed about the two groups of patients.Difference between the two groups was determined by the Student' s t-test.Single factor analysis of variance was used within the group.P ＜ 0.05 was considered statistically significant.Results Compared with the patients in group B,the MMPs levels in group A at 24、48 and 72 h after the operation were significantly lower.The patients in group A had lower levels of NT-proBNP and NE both at 48 h and 72 h after the operation.Lower levels of TNF-α and CRP were also found at 24 h and 48 h in this group.The MODS score at the fifth 、tenth and 15th day after the surgery were both significantly lower than that of the first day in patients of group A.Conclusion Dexmedetomidine can inhibit the inflammatory response during the aortic dissection perioperative period and can reduce the acute injury of organs caused by the excessive systemic inflammatory response.

A total of 107 vitiligo patients were randomly divided into 3 groups.Group A received an intralesional injection of Bacillus Calmette-Guérin-polysaccharide nucleic acid (BCG-PSN) (n =34),group B Compound Glycyrrhizin Tablets (n =36) and group C both (n =37).Before treatment and 3 months after treatment,cellular immune function was detected for each group.Paired comparisons of 3 groups before and after treatment showed that CD4 +,CD4 +/CD8 + ratio increased (all P ＜ 0.05) and CD8 + decreased (P ＜0.05).After treatment,as compared with groups A and B,CD4 + increases (both P ＜ 0.05) and CD8 + decreased in group C (P ＜0.05).Group C had an efficiency rate of 91.9％ and it was higher than the other two groups (both P ＜ 0.05).An intralesional injection of BCG-PSN plus Compound Glycyrrhizin Tablets could improve immune function and treat vitiligo patients efficiently.

Objective To investigate the correlation of possible risk factors with acute renal injury (AKI) after coronary artery bypass surgery (CABG) and explore if the incidence of AKI could be lower by off-pump CABG for kidney protection.Methods Two hundred and nine patients who underwent coronary artery bypass surgery in Nanjing First Hospital from September 2010 to November 2013 were recruited.The patients were divided into AKI group (fifty-five cases) and non-AKI group (one hundred and fifty-four cases) according to the AKI criteria and compared the possible risk factors between two the groups by univariate analysis and multivariate analysis.Results The index of female gender,body mass index,age,hypertension,basic serum creatinine,ejection fraction,the number of coronary atherosclerosis,cardiopulmonary bypass,IABP for circulatory support,postoperative low cardiac output,lactate in AKI group were higher than that in non-AKI group by univariate analysis (P ＜ 0.05).And basic serum creatinine,ejection fraction,cardiopulmonary bypass,postoperative low cardiac output showed a significantly statistical difference between two group by multivariate analysis.Conclusions Cardiopulmonary bypass,basic serum creatinine,ejection fraction,postoperative low cardiac output were independent risk factors.Off-pump CABG could benefit for kidney protection.

Objective To evaluate the hypothesis that neutrophil gelatinase-associated lipocalin(NGAL) ,kidney injury molecule-1(KIM-1)and Interleukin-18(IL-18) are early biomarker for acute kidney injury (AKI) in patients after coronary artery bypass graft surgery(CABG) .Methods 80 patients were recruited during September 2011 to May 2012 .The patients were divided into two groups according to the AKI criteria ,patients developed postoperative AKI in AKI group ;others did not postoperative developed AKI in non-AKI group .Before and 2 ,4 ,6 ,8 ,12 ,24 h after the CABG surgery ,the urine and serum sample were collected ,serum creatinine ,the urine and serum IL-18、NGAL、KIM-1 value were test by ELISA method .Results 13 of 80 cases(16 .25% )developed postoperative AKI according to the AKI criteria ,diagnosis with serum creatinine was only 12-48 h after cardiac surgery .Concen-trations of NGAL 、IL-18 in urine and serum at 2 h after CABG surgery ,concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI by logistic regression analysis and ROC curve .Conclusion IL-18 in urine and serum at 2 h after CABG surgery were the powerful independent predictors of AKI ,and concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI .Serous NGAL and IL-18 is better than urinary NGAL and IL-18 in diagnosis of AKI . Urinary KIM-1 was better than serous KIM-1 in diagnosis of AKI at 6 h .

Objective To test the hypothesis that interleukin-18 (IL-18) in the urine and serum sample are early biomarker for acute kidney injury (AKI) in patients after coronary artery bypass graft surgery (CABG).Methods Eighty patients who underwent CABG were recruited.The patients were divided into AKI group and non-AKI group according to the AKI criteria.The urine and serum sample were collected at pre-operation and 2 h,4 h,6 h,8 h,12 h,24 h after the CABG.The urine and serum IL-18 value were test by ELISA method.Receiver-operating characteristic cue(ORC) and the area under the cure(AUC) asses the sensitivity and specificity of IL-18 for AKI.Results Thirteen of eighty cases(16.25％) developed postoperative AKI according to the AKI criteria.Diagnosis with creatinine was only 24-48 hours after CABG.The serum and urinary concentrations of IL-18 at mostly each time point after CABG in AKI patients were significantly higher than those in non-AKI patients(P ＜ 0.01).Urinary and serous concentrations of IL-18 peaked at 4 h after CABG in AKI patients.ROC curve showed AUC in urinary and serous concentrations of IL-18 at 2 h ＞ 0.8 ; Concentrations of IL-18 in urine and serum at 2 h were the powerful independent predictors of AKI by logistic regression analysis.Conclusion IL-18 in urine and serum after CABG surgery were the powerful independent predictors of AKI.

Obiective To investigate acid-suppression efficacy of proton pump inhibitors(PPls) in relation to CYP2C19 genetic polymorphism on patients with peptic ulcer. Methods By an open, randomized and control trial, fifty nine patients with active peptic ulcer were randomly assigned to receive one of three PPIs on a single dose (20 mg of each drug): omeprazole group (n=19), rabeprazole group (n=20) and esomeprazole group (n=20). lntragastric pH was recorded 1 hour before and 24 hours after administration. CYP2C19 genotype was tested in all patients. Resuits The EMs/PMs ratio of each group was 16/3,17/3 and 17/3, respectively. The total time that intragastric pH＞4, time percent pH＞4 and median pH in PMs patients were significantly higher than those in EMs patients of omeprazole group (P＜0.05). But all these differences were not found in rabeprazole group and esomeprazole group. The pH of nocturnal acid breakthrough (NAB) in both rabeprazole group and esomeprazole group was higher than that of omeprazole group, while there was no significant difference between rabeprazole group and esomeprazole group. Gonclusion The acid-suppression efficacy of omeprazole is highly dependent on CYP2C19 genetic polymorphism, while CYP2C19 genetic polymorphism may have a little influence on the acid-suppression efficacy of rabeprazole and esomeprazole. The acid-suppression action of rabeprazole and esomeprazole is superior to omeprazole, especially on night acid secretion.