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 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 analyze warfarin anticoagulation therapy for patients after heart valve replacement,and to explore an optimal intensity of warfarin anticoagulation.Methods The administration method,international normalized ratio (INR) monitoring of 265 patients who received warfarin anticoagulation therapy after heart valve replacement were analyzed retrospectively.The patients were divided into three groups according to different valve prostheses:aortic valve replacement (AVR) group (37 cases),mitral valve replacement (MVR) group (165 cases) and double valve replacement (DVR) group (63 cases).Each group was divided into two subgroups according to their INR levels (INR 1.5-2.0,INR 2.1-2.5).The occurrence of bleeding and thromboembolic events in these subgroups were compared.Results A total of 265 cases were visited,and followed up for 4 months to 6 years.The dose of warfarin was 0.625-7.500 (2.5 ± 1.4) mg/d.The incidence of anticoagulation adverse events was 23 cases.The incidence of bleeding events was 6.79％ (18/265),which was higher than that of thromboembolic events (1.89％,5/265),and there was significant difference (P ＜ 0.05).Four cases of the hemiplegia sequelae occurred and 2 cases died.The incidence of bleeing events in patients with INR1.5-2.0 in AVR group,MVR group and DVR group were 0 (0/20),3.57％ (3/84),2.70％ (1/37),in patients with INR 2.1-2.5 were 1/17,11.11％ (9/81),15.38％ (4/26),and there were significant differences (P ＜ 0.05).There were no significant differences in the incidence of thromboembolic events between INR 1.5-2.0 and INR 2.1-2.5 in AVR group,MVR group and DVR group (P ＞ 0.05).Conclusions After heart valve replacement,the anticoagulation therapy with warfarin is effective and safe to maintain the low intensity anticoagulation (INR1.5-2.0).AVR and MVR/DVR may benefit from a treatment strategy with levels ranging from 1.5-1.8 and 1.8-2.0,and the anticoagulation therapy of individuation should be formulated according to different conditions.

Objective:To study the influence of all-trans retinoic acid (atRA)on craniomaxillofacial development of C57 mice. Methods:Pregnant C57BL mice were divided into 4 groups(n =5)at gestation day (GD)1 0.Mice in three atRA-induction groups were given atRA of 60,80 and 1 00 mg/kg,respectively.The mice in control group were given the equivalent volume of corn oil.All pregnant mice were sacrificed at GD1 9 and the embryos were collected.Stereo microscope was used to observe the craniomaxillofacial morphology.Standardized radiographs were taken and cephalometric analysis was performed.Results:The embryonic body length and body mass of control group surpassed those of 80 and 1 00 mg/kg atRA groups(P <0.05,P <0.01 ).atRA induced craniomaxillofacial malformations and maldevelopment.The mice induced by atRA exhibited a shorter mandibular body and more retrusive position of max-illary and mandibular(∠NAK and ∠NBD)when compared with their norm(P <0.01 ).Significant decrease in craniofacial length (Op-Rh)was observed in all atRA-induced groups(P <0.01 ).Decreases in cranial vault height(Fp-Os)and cranial vault length(Pa-Na)dimensions were observed in 80 and 1 00 mg/kg atRA groups(P <0.05,P <0.01 ).Conclusion:Exogenous atRA dose-depend-ently induces retardation of craniomaxillofacial morphology in embryo of C57BL mice by inhibition of the sagital and vertical dimension development of the bone.

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.

ObjectiveTo evaluate the influence on left ventricular(LV) twist,and the relationship between LV twist and function in the rabbits with ventricular aneurysm formed after myocardial infarction by two-dimensional ultrasound speckle tracking imaging.MethodsTwenty-six healthy rabbits were divided into two groups,six as control group,twenty as experimental group.The model of myocardial infarction and ventricular aneurysm were established by ligaturing left anterior descending coronary artery and left circumflex artery.After four weeks,according to the pathological examination of whether ventricular aneurysm formed or not,the experimental group was divided into myocardial infarct group and ventricular aneurysm group.Echocardiography was performed to measure rotations (at the levels of mitral annulus and apex in LV short-axis view),LV twist,left ventricular cavity size and function.ResultsCompared with the myocardial infarct group,LV end-diastolic diameter(LVEDD) and LV end-diastolic volume(LVEDV) were larger in the ventricular aneurysm group,but LV ejection fraction (LVEF),LV fractional shortening (LVFS),apical rotation and LV twist were lower in the ventricular aneurysm group than the myocardial infarct group.Both apical rotation and LV twist had shown a great correlation with LVEF.The conclusion was also shown in the ROC curve that sensitivity and specificity of diagnosis cardiac dysfunction were 76.9％ and 80.0％ respectively when the apical rotation was 1.21°.Conclusions There was a closely relationship between the change of apical rotation and the LV systolic function.When the apical rotation dropped to 1.21°,an apparent decline of LV systolic function was implied.

Objective To evaluate left atrial (LA) function by real-time three-dimensional echocardiography (RT-3D) and speckle tracking imaging (STI) after circumferential ablation of pulmonay vein ostia for atrial fibrillation guided by carto mapping system. Methods Thirty patients who had ablation procedure for paroxysmal atrial fibillation were accepted echocardiography to estimate the LA function at pre-operation,3 days and 3 months of post-operation. The LA maximal, minimal and pre-systolic volume (LAVmax, LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured by RT-3DE respectively. The strain rate curve was acquired in each LA segment (anterior, posterior, lateral, inferior and septal) by STI. Systolic strain rate (SRs), early diastolic strain (SRe) and late diastolic strain rate(SRa) of each left atrial segments were measured. Results Comparing with preoperative,3 days post-ablation SRs,SRe and SRa decreased significantly in each wall of LA. After 3 months,SRa and SRe in anterior, inferior and septal were significantly improved, however, SRs showed no significant difference. LAVmax and LAVpre were significantly decreased. LAPEF and LAAEF were significantly improved. Conclusions The patients with circumferential pulmonary vein ablation were in a deterioration after three days. The pump function and conduit functions of left atrial were increased after 3 months.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; methods ; Tomography, X-Ray Computed ; methods ; Tumor Burden

Objective To investigate the efficacy of acupuncture and rehabilitation therapy on lower limb motor function, and to explore a cortical mechanism using functional near infrared spectroscopy (fNIRS). Methods From December, 2020 to July, 2021, 24 stroke patients with lower limb motor dysfunction in our hospital were randomly divided into rehabilitation group (n = 12) and acupuncture-rehabilitation group (n = 12), and received routine rehabilitation training and acupuncture-rehabilitation intervention for four weeks, respectively. The control group included ten healthy subjects matched the patients. Before and after intervention, the lower limb motor function of the patients was assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), and all the subjects accepted fNIRS examination. The functional intensity and lateralization index (LI) of supplementary motor area (SMA), premotor cortex (PMC) and sensory motor cortex (SMC) were calculated based on oxygenated hemoglobin (HbO2). Results There was no significant difference in FMA-LE score between the rehabilitation group and the acupuncture-rehabilitation group before the intervention (P > 0.05). After four weeks of intervention, FMA-LE scores improved in both groups (t > 3.770, P < 0.001), and improved more in the acupuncture-rehabilitation group than in the rehabilitation group (t = 2.252, P < 0.05). Before intervention, the average functional connection was more intensitive in the control group than in the two patients groups (P < 0.05), and there was no significant difference between the later two groups (t = 0.458, P > 0.05). After intervention, the average functional connection increased in both groups (t > 2.178, P < 0.05), and the functional connection of the affected PMC of acupuncture-rehabilitation group increased (P < 0.05). The LI in SMC increased in the acupuncture-rehabilitation group (P < 0.05). There was a significant positive correlation between the change of functional connection of the affected PMC and the change of FMA-LE scores in the acupuncture-rehabilitation group (r = 0.579, P < 0.05). Conclusion Acupuncture with rehabilitation therapy can significantly improve the lower limb motor function and asymmetrical activation of SMC in stroke patients. The recovery of lower limb motor function may be related to the enhanced activation of affected PMC.

Objective To investigate the effects of recombinant human fibronectin fragment (RetroNectin) combined with anti-CD3 monoclonal antibody (CD3Ab) on the proliferation and cytotoxicity of cytokine-induced killer cells (CIK) from acute leukemia (AL). Methods Mononuclear cells (MNCs) were isolated from peripheral blood of complete remission AL pa-tients. The MNCs were cultured in vitro by precoating with RetroNectin (RN group), CD3Ab (CD3Ab group), RetroNectin com-bined with CD3Ab (RN+CD3Ab group) and traditional method (control group) to generate CIK. The changes of growth rate, characterization, cytotoxicity and apoptosis of CIK were determined between groups. Results The amplification of CIK was higher in experimental group than that of control group, and the amplification of CIK was higher in group RN+CD3Ab than that of in group RN and group CD3Ab (P＜0.05). The expression of CD25 positive cells was higher in group RN and group RN+CD3Ab than that of group CD3Ab and control group (P＜0.05).The percentage of G1 stage cells was lower in group RN and group RN+CD3Ab than that of group CD3Ab and control group. The percentage of S stage cells was higher in group RN and group RN+CD3Ab than that of group CD3Ab and control group (P＜0.05). The cytotoxicity was higher in group RN and group RN+CD3Ab than that of group CD3Ab and control group (P＜0.05) at the E/T scope 40∶1.The percentage of apoptotic cells was lower in group RN and group RN+CD3Ab than that of group CD3Ab and control group (P ＜ 0.05). Conclusion These in vitro studies suggest that a higher activity of immune cells could be obtained by CIK cells cultured by precoating Ret-roNectin and CD3Ab.