Objective To investigate the related risk factors,clinical features and prognosis of hospital-acquired acute kidney injury (AKI) in intensive care unit (ICU).Methods We retrospectively analyzed 48 patients with both acute kidney injury and multiple organ dysfunction syndrome (MODS),who received renal replacement therapy from October 2006 to February 2011 in our ICU.According to whether the occurrence time of AKI was 48 hours after admission,they were divided into hospital-acquired AKI (HA-AKI) group and community-acquired AKI (CA-AKI) group,with 13 and 35 cases respectively.We compared the differences between these two groups in gender,age,acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ),primary diseases,days of mechanical ventilation,times of renal replacement therapy,number and indicators of organ failure,prognosis,renal function recovery,length of stay in ICU and hospital.Results The mean age of HA-AKI group is ( 64.5 ± 21.4) years,which is older than that in CA-AKI group ( 50.2 ± 17.5 ) years (P=0.022).The top three primary diseases in CA-AKI group are severe infection(42.8％ ),chronic kidney disease (CKD) concurrency of AKI ( 11.4％ ) and multiple trauma without head injury ( 8.6％ ).However severe infection still occupies the first in HA-AKI group ( 30.8％ ),followed by stroke (23.1％,P=0.024),multiple trauma with head injury( 15.4％,P=0.018 ) and gastrointestinal bleeding( 15.4％ ) ;Patients in HA-AKI group with more than four organ failures account for 84.6％,significantly higher than 65.7％ in CA-AKI group (P=0.000).On the first day,the levels of serum sodium ( P =0.036 ) and bicarbonate ( P=0.001 ) in HA-AKI group are higher than that in CA-AKI group,and the urinary volume is more(P =0.046).In HA-AKI group,the level of urea nitrogen on the seven day increases so progressively that it becomes significantly higher than that on the first day(P=0.015),but in CA-AKI group,there is no significant change in the levels of serum creatinine and urea nitrogen after AKI,while the levels of seruum sodium ( P=0.023 ) and bicarbonate ( P=0.030) increase significantly;APACHE Ⅲ score in HA-AKI group after admission 24 hours is significandy lower than that in CA-AKI group(53.2 ±22.8) point vs (89.1±25.7) point,P=0.000),and the length of stay in ICU and hospital and days of mechanical ventilation in HA-AKI group are significantly longer than that in CA-AKI group,but there are no significant differences in times of RRT therapy,prognosis and recovery of renal function.Conclusion APACHE Ⅲ score after 24 hours of admission does not accurately reflect the prognosis of patients with MODS and HA-AKI.There are great differences in age,primary diseases,organ function changes and other aspects of HA-AKI when compared with CA-AKI.

Objective To investigate dynamic changes of extracellular signal regulated protein kinase (ERK) 1/2 in lung fibroblast of newborn rats with chronic lung disease (CLD) caused by hyperoxia.Methods Full-term newborn rats were randomly divided into two groups:air-exposed group and hyperoxia - exposed with 90％ oxygen group.Rats were sacrificed separately 3 d,7 d and 14 days after exposure to air or 90％ oxygen. Then lung fibroblasts of rats were isolated and primarily cultured. By using Immunocystochemistry,Western-blot and RT-PCR methods,the levels of ERK1/2 protein and expressions of ERK1/2 mRNA were measured. Results The levels of p-ERK1/2 protein in lung fibroblast in the hyperoxia group were significant higher on the 7th day and 14th day after exposure to 90％ oxygen compared with those in the air-exposed group (P ＜0.01 ).And the levels of total ERK1/2 protein and expressions of ERK1/2 mRNA did not change noticeably and were not significantly different between two groups (P ＞0.05 ).Conclusions The activation of phosphorated ERK1/2 may lead to lung fibrosis caused by hyperoxia in newborn rats.

Air ; analysis ; Air Pollutants, Occupational ; analysis ; Chromatography, Gas ; methods ; Styrenes ; analysis ; Workplace

ObjectiveTo study the expression and the role of α-smooth muscle aetin (α-SMA) and collagen Ⅰ ( Col Ⅰ ) in lung fibroblasts of newborn rats with hyperoxia-induced lung injuries.Methods Thirty full-term newborn Wistar rats were randomly assigned to hyperoxia group (90％ oxygen exposure,n =15 ) and air group (room air exposure,n =15) within 12 h after birth.Then lung fibroblasts were isolated and primary cultured from rat lungs on postnatal 3 d,7 d,and 14 d.The distribution of α-SMA protein were measured by immunohistochemistry.The levels of Col Ⅰ were detected by ELISA.ResultsThere were no significant differences in the levels of α-SMA and Col Ⅰ expressions between the two groups at 3 d ( P＞0.05 ).While the expression of α-SMA ( 112.60 ± 4.61 vs 94.69 ± 2.38,200.30 ± 3.97 vs 103.04 ± 1.91,P＜0.01 ) and Col Ⅰ protein [ ( 28.66 ± 1.15 ) μ.g/L vs ( 24.62 ± 3.15 ) μg/L,( 30.60 ± 0.65 ) μg/L vs (27.46 ± 1.68 ) μg/L,P ＜ 0.05 ] in lung fibroblasts caused by hyperoxia were significantly higher than those in air-exposed group on postnatal 7 d and 14 d.There was positive correlation between α-SMA and Col Ⅰ protein ( r =0.72,P＜0.01 ).ConclusionHyperoxia promotes differentiation of lung fibroblasts into myofibroblasts,and synthesis of type Ⅰ collegen in neonatal rats,which leads to lung fibrosis finally.

Objective To analyze the effect of duloxetine on S100B and signal pathway ERK1/2-NF-κB expression in hippocampus in depression rat.Methods Chronic unpredictable mild stimulation was used to establish depressive model rats (n=50).They were randomly divided into no-intervention group (n=10),different treatment time of duloxetine group (C,D,E,F group,10 rats in each group)and then 10 normal rats were selected as control group.Behavior tests including open-field test and the saccharine preference test were used to test the behavioral change of rats after 28 days intragastric administration.Western blot was used to detect S100B,t-ERK1/2,pERK 1/2,t-NF-κB and pNF-κB expression in hippocampus.Results In open-field test,the crossing score,rearing score and latency of the rats in E,F group were (69.68± 14.61) and (70.66± 11.53) score,(20.94 ± 10.92) and (20.32±8.85) score,(1.1±0.4)s and(1.0±0.4) s respectively,and showed no significant difference with those of control group ((71.19±12.08) score,(20.42±8.76) score,(1.0±0.3)s) after 28 d intragastric administration (P＞0.05),while the level score,vertical score were significantly higher than those in depressive model (P＜ 0.05).In the saccharine preference test,the rats in E,F and control group exhibited increased saccharin preference compared with depressive model rats (P＜0.05).The rats in E,F and control group exhibited increased S100B,pERK1/2 and pNF-κB expression in hippocampus compared with depressive model rats (P＜0.05).Conclusion Duloxetine improves the behavioral ability of depression rat and exerts effect after 2 weeks.The ERK1/2-NF-κB signal pathway in hippocampus may participate in this mechanism.

Objective To study the interobserver variabilities and the differential diagnosis value of Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon for small ( ≤ 2 cm) breast nodules. Methods Between January 2009 and December 2011, 289 patients with small (≤2 cm) breast nodules (n=317) were included. According to sizes, the lesions were divided into two groups, i.e., 0-1 cm (n=160) group and 1-2 cm (n=157)group. Each lesion was described independently by 3 radiologists using BI-RADS-US lexicon. Interobserver variabilities were assessed by Kappa test. Chi-square test was used to compare the frequency difference of the descriptors between malignant and benign lesions. Sensitivity, speciifcity, accuracy, positive predictive value and negtive predictive value were calculated. Results (1)Moderate agreements were obtained for lesion shape, orientation, margin, echo pattern, surrounding tissue and calciifcations (κ=0.44, 0.57, 0.48, 0.43, 0.51 and 0.57) in 0-1 cm group. Substantial agreements were obtained for lesion shape, orientation, margin and echo pattern (κ=0.65, 0.61, 0.64 and 0.63) in 1-2 cm group. (2)Irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo and microcalciifcations were more frequently found in malignant nodules than in benign nodules in 0-1 cm group [52.3% (34/65) vs 20.0% (19/95), 38.5%(25/65) vs 13.7%(13/95), 75.4%(49/65) vs 32.6%(31/95), 18.6%(12/65) vs 0 (0/95) and 10.8%(7/65) vs 2.1%(2/95);χ2=18.19, 13.08, 28.22, 16.39 and 3.95;P=0.000, 0.000, 0.000, 0.000 and 0.047]. Similarly, irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were signiifcantly more frequent found in malignant nodules than in benign nodules in 1-2 cm group [74.2%(49/66) vs 12.1%(11/91), 36.3%(24/66) vs 5.5%(5/91), 93.9%(62/66) vs 22.0%(20/91), 37.9%(25/66) vs 3.3%(3/91), 30.3%(20/66) vs 7.7%(7/91), 15.2%(10/66) vs 0 (0/91) and 16.7%(11/66) vs 4.4%(4/91);χ2=62.59, 24.21, 79.40, 31.22, 13.73, 12.30 and 6.67;P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000 and 0.010]. (3)In both groups, a good sensitivity was demonstrated (75.4%&93.9%) when using the non-circumscribed margin as a criterion for malignancy, and high speciifcity was achieved in two groups (80.0%-100%and 87.9%-100%) when other descriptors including irregular shape, non-parallel orientation, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were used as differentiation criteria. Conclusions Good interobserver agreement can be achieved using the BI-RADS-US lexicon in the diagnosis of small breast nodules. Non-circumscribed margin are proved as the most valuable sign for screening malignant breast lesions ≤ 2 cm. High speciifcity was found for irregular shape, nonparallel orientation, echogenic halo, shadowing, Cooper′s ligament changes and microcalciifcations, which can help biopsy and preoperative diagnosis.

Objective To investigate the detectable rate and correlative factors of behavior problems among Hui nationality left-behind children in Ningxia rural area.Methods 1394 children,between 6 and 15 years old,of which 282 were Hui nationality children and 112 were Hui left-behind children,were selected from six primary schools and two junior middle schools using cluster random sampling method in Yongning,Ningxia.All of them were assessed by the Achenbach 's Child Behavior Checklist (CBCL) and self-designed General Information Questionnaire.Logistic regression method was used to analyze the correlative factors of behavior problems.Results The detectable rate of behavior problems among Hui nationality children between 6 and 15 years old was 31.25％,which was higher than the Han nationality left-behind children' s(17.84％) and Hui nationality nonleft-behind children' s (14.12％).Among the Hui left-behind children,those who between 6 and 11 years old,had been left alone between 5 and 7,and whose parents exchanging ideas with teachers less than one time a month had higher detectable rates (x2 =14.904,6.327,7.904,P ＜ 0.05).Among the Hui ethnic children,the detectable rates of those who between 6 and 11 yeas old were higher than that of the non-left-behind children' s(P ＜ 0.05).Logistic regression analysis showed that Hui ethnic left-behind children between 12 and 15 years old (OR =0.179) and those whose parents contacted with their teachers frequently(OR =0.362) had less possibilities to attach behavior problems.Conclusion The detectable rate of behavior problems among Hui nationality left-behind Children between 6 andl5 years old in Ningxia is higher,and the correlative factors are complex.

Objective To evaluate the results of rotary self-locking intramedullary nail (RSIN) for treating long tubular bone fracture of extremities, and discuss the current problems. Methods One hundred and twenty-two patients with long tubular bone fracture of extremities,including 59 femoral fractures,57 tibial fractures and 6 humeral fractures,who had been treated by RSIN were retrospectively investigated. Results All of the patients achieved clin-ical healing,with an average time of 24 weeks. Nobody was found to appear maluniun,infection and the break of inter-nal fixture. Internal fixations were removed after the fracture healing,with an average time of 14 months. It was diffi-cult to remove the internal fixations in 5 cases, and one case refractured after removing the internal fixations. Conclu-sion RSIN has the advantages such as easy operation,less trauma,no pendulum effect,early motion after operation and so on, except the characters of general interlocking intramedullary nail such as anti-rotation, anti-crispition and anti-displacement.

Objective To understand the pathogenesis of primary hypothyroidism associated with polymyositis-like syndrome.Method Four cases were presented and the clinical characteristics were analyzed.Results All of the four patients were male.Complaints of weakness primarily affecting proximal muscles and elevation of muscle enzymes were presented.Primary hypothyroidism was diagnosed after clinical examination.Complaints of weakness and the elevated muscle enzymes were all improved after the substitution of thyroxine.Conclusion Hypothyroidism could cause polymyositis-like syndrome,and thyroid function should be screened when elevation of muscle enzymes is presented.

OBJECTIVETo study the effects of combined use of total alkaloids (TA) of Uncaria rhynchophylla (UR) and Coryadlis ambailis migo (CAM) on cerebral ischemia/reperfusion injury in rats.

METHODSRat model of middle cerebral artery ischemia/reperfusion was established, the changes of neurological state was scored before and after treatment with the two kinds of TA, single or combined, and the changes of cerebral infarcted volume, cerebral water content, activities of NOS and SOD and content of MDA in rats' brain were estimated as well.

RESULTSAfter being treated with the combination of both TA, the average neurological score, cerebral infracted volume, cerebral water content, activity of NOS and content of MDA in the model rats significantly decreased, and the activity of SOD was significantly increased (all P < 0.05). The effect of combined use of the two TA was higher than that of use TA of UR or CAM alone (P <0.05). Moreover, the central nervous system inhibitory effect induced by combined TA was significantly weaker than that of UR.

CONCLUSIONCombined use of TA of UR and CAM may facilitate the protection against cerebral ischemia/reperfusion damage, the action mechanism might be relevant to reducing the lipid peroxidation injury of brain cells through inhibiting the NOS activity and increasing the SOD activity.

Alkaloids ; pharmacology ; therapeutic use ; Animals ; Brain ; blood supply ; drug effects ; enzymology ; Brain Ischemia ; complications ; Corydalis ; chemistry ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Male ; Mice ; Neuroprotective Agents ; pharmacology ; therapeutic use ; Nitric Oxide Synthase Type I ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; etiology ; prevention & control ; Superoxide Dismutase ; metabolism ; Uncaria ; chemistry