Chronic kidney disease (CKD) is a general term for heterogeneous disorders affecting kidney structure and function.It can be detected by routine laboratory tests.Acute kidney injury ( AKI),previously referred to as acute renal failure(ARF), represents a persistent problem in clinical medicine.Despite significant improvements in therapeutics,the mortality and morbidity associated with AKI remain high.A major reason for this is the lack of markers for early diagnosis of AKI.In this paper,we discuss recommendations for AKI and CKD laboratory assessment and management,and future challenges.( Chin J Lab Med,2012,35:773-779)

Objective:To provide references for policy-making on the establishment of a sound healthcare sys-tem for China’s aged population. Methods:Based on the framework of The Behavioral Model of Health Services Use and data from China Health and Retirement Longitudinal Study in 2011 , the Tobit model of aged population’s health expenditures is built. Results: Self-rated health conditions, chronic disease, medical insurance, endowment insur-ance, self-rated living standard, age, gender, marital status and urban-rural character are the significant determi-nants. Conclusions:The healthcare system for China’s aged population should be built through simultaneously apply-ing disease prevention and access facilitation policies and the characteristic differences of different groups of aged pop-ulation should be taken into consideration.

Objective To explore the treatment protocols and the occurrence and developmental rule of subcutaneous multiple inflammation and indurations by facial injection lipolysis,and to summarize the treatment experience.Methods Six cases of subcutaneous indurations were females patients with facial injection lipolysis,and the lesions increased slowly after about one month.The local temperature raised and pinching pain appeared in the facial area.The other secondary post-traumatic swelling and scleroma areas were treated with piercing or cutting,spread to the surrounding tissues.Red scleroma became osmosis,by local open decompression,debridement,irrigation and drainage lasting almost 3 months.The area had burst out mucoid funicular materials gradually.Results The facial injection lipolysis caused regionally red swelling and scleroma gradually with 1 month of continuous irrigation drainage.The red scleroma area was limited with debridement again after maturation,closed incision after discharge mucus-shape substance by its organization.In the redness induration period,pathological results showed the homogeneous materials without structure could be seen in the fibrous tissue,with surrounding hyperemia,hemorrhage associated with inflammation.Festering burst period showed that local tissue presented suppurative inflammation,multiple abscesses and granuloma formation.Conclusions Conservative treatment can lead to swelling,bursting and developing into deep tissues.Surgical treatment can spread redness scleroma area and lead to a large area of skin depression,soft tissue scar and deformity.

Objective To explore the clinical diagnostic value of serum human chorionic gonadotropin beta subunit (β-HCG) and alpha fetoprotein ( AFP) in mediastinal germ cell tumors .Methods A retrospective analysis was conducted on the patients who were definitely diagnosed as mediastinal tumors or mediastinal neoplastic lesions .A total of 133 patients were included for analysis between January 2008 and May 2014, divided into two groups.42 cases of mediastinal germ cell tumor patients were marked as case group while 91 cases of other mediastinal tumor or mediastinal neoplastic lesion patients were marked as control group ( including 31 cases of thymoma , 10 cases of mediastinal neurogenic tumor , 2 cases of intrathoracic goiter , 25 cases of mediastinal cyst , 2 cases of mediastinal lipoma , 11 cases of mediastinal lymphoma and 10 cases of thymic carcinoma ) .AFP was detected by chemiluminescence detection , and -HCG was detected by electrochemical luminescence .K-S test was performed to investigate normality of data , non-normally distributed data were described as Median ( interquartile range ) .Mann-Whitney U test was done for measurement of data between two groups .Logistic regression analysis was performed as multivariate analysis.Receiver operating characteristic curve ( ROC) was used to determine the cut-off values.Results The levels of serum AFP and β-HCG in case group were 13.26 (2.39-48.09) ng/ml and 1.99 (0.10-15.7) IU/L, respectively, significantly higher than those in control group [AFP:2.47 (1.78-3.16) ng/ml,β-HCG:0.10 (0.10-0.55) IU/L].The difference of levels of AFP and β-HCG between the case group and the control group were statistically significant ( P=0.000 ) .There were no significant difference when it comes to β-HCG between the case group and intrathoracic goiter patients in control group .Apart from it, the difference of levels of AFP and β-HCG between the case group and every single control group were statistically significant .Cut-off values of AFP and β-HCG for distinguishing mediastinal germ cell tumors from mediastinal tumors were 5.07 ng/ml and 2.32 IU/L.In this scenario, for AFP and β-HCG, sensitivity were 57.1%and 50%, specificity were 97.8%and 96.7%, accuracy were 54.9%and 46.7%, area under the curve ( AUC ) were 0.773 and 0.755, positive likelihood ratios were 26.00 and 15.17respectively.Parallel experiments contributed to increase the sensitivity to 71.4%. Predictive probability (P) =1/[1+exp ( -0.319AFP-0.253HCG+2.850)] was obtained by logistic regression model.When cut-off value of predictive probability ( P ) was 0.30, specificity, AUC, and positive likelihood ratio were increased to 98.9%, 0.835 and 65.00respectively, negative likelihood ratio was decreased to 0.29, positive predictive value and negative predictive value were increased also (96.8%and 88.2%respectively).Conclusion Serum β-HCG, AFP and predictive probability ( P ) is valuable in the diagnosis of mediastinal germ cell tumor .

The Lazarus phenomenon is defined as delayed ROSC,or ROSC after failure of CPR and cessation of all the emergency medical care,including the cessation of chest compression,mechanical ventilation,and venous fluid resuscitation.It was first reported in 1982 and 53 cases of Lazarus phenomenon have been reported in the medical literature so far.Even though Lazarus phenomenon is rare and the pathophysiological mechanisms are poorly understood,several possible mechanisms are still proposed,which could be rational to explain this phenomenon,such as auto-PEEP,hyperkalemia,alkalosis,delayed action of drugs,etc.In most cases,it was reported that ROSC occurred within 10 minutes after cessation of medical effort.Therefore,before the announcement of death of patient,it is mandatory to monitor those patients for at least 10 minutes after the cessation of CPR.However,more explicit studies seem to be necessary to gain a better understanding of this phenomenon.

Objective To discuss the influence of μ-opioid receptor ( OPRM1) and CYP3A gene polymor-phism on analgesic effect of fentanyl for abdominal hysterectomy patients .Methods 198 cases of gynecologic anes-thesia patients who were treated by elective abdominal hysterectomy surgery ,were selected in the hospital .The rela-tionship between the fentanyl consumption of intravenous analgesia and OPRMI and CYP 3A gene polymorphisms was detected by using polymerase chain reaction-restriction fragment length polymorphism detection .Results In 198 pa-tients,OPRM1 genotyping was 186 cases,the other 10 patients failed to typing were excluded ,including 89 cases of type A/A,type A/G 76 cases,type G/G 21 cases,OPRM1 the frequency of A118G allele was 31.7%.No statistically significant differences were found in mean VAS score of CYP 3A4*1/*1,CYP3A4*1/*1G,CYP3A4*1G/*1G instantly after operation in the three groups and 24h postoperation.By using analysis of variance with body mass ,age and intraoperative volume as a covariate factors after first 24h fentanyl consumption ,the difference was statistically sig-nificant among the three groups (P<0.05),CYP3A4*1G/*1G group was significantly lower than that in CYP3A4*1/*1G group and CYP3A4*1/*1 group,there was no significant difference between CYP 3A4*1/*1G group and CYP3A4*1/*1 group (P>0.05).In addition,because the OPRM1 A118G interacts with CYP3A4*1G, reducedthe quantity of expression of opioid receptor carrying CYP 3A4*1 and OPRM1 A118G/G,and thus more fent-anyl was needed postoperation to achieve the same effect .Conclusion It provided a theoretical basis and reference for clinical application of personalized medicine by analyzing the gynecological patients μopioid receptor gene A118G and CYP3A4*1G polymorphism.

Objective To investigate the clinical value of whole blood red cell distribution width ( RDW) in discriminating lung cancer metastasis.Methods A retrospective analysis was conducted on the patients who were initially diagnosed as primary lung cancer.A total of 525 patients were included for analysis between January 2012 and July 2013,stratified by different stages and metastasis scenarios.RDW data was investigated.Kruskal-Wallis H tests were performed to know the difference of RDW without and within groups.Spearman correlation test was done subsequently to further analyze the correlationship among RDW and clinical parameters.Results RDW was14.5 ( 13.0-15.4 )%in patients with metastasis , which was significantly higher than those without metastasis [12.7 (12.3-13.0)%].Further analysis indicated a similar ascending trend in cases that already had distant or multiple organ invasion.For example,RDW was 14.6 (12.9-15.4) %in patients of stage ⅢtoⅣ,while was 12.6 (12.2-13.1) %in patients of stageⅠtoⅡ.RDW was correlated to lung cancer metastasis and stage advancement.Areas Under Curve ( AUCs) of ROC for lung cancer metastasis and distant metastasis were 0.823 ( 95% CI:0.787-0.859 ) and 0.710 (95%CI:0.655-0.765) respectively,indicating a promising accuracy.The Cut-off value for discriminating lung cancer with/without metastasis was 14.25% with sensitivity being 56.8% and specificity being 98.3%.Conclusion RDW may be a novel biomarker for auxiliary diagnosis of lung cancer metastasis and could be useful to understand state of illness.

The method of flying through the air is a qi-promoting and qi-circulating technique commonly used in clinical acupuncture. It includes four methods: the blue dragon wagging its tail, the white tiger shaking its head, the green turtle probing the cave and the red phoenix winging to the source and functions to circulate bodily meridian qi. The method of flying through the air was firstrecorded in Golden needle Fu. Later and modern doctors developed it on the basis of Golden needle Fu. This article straightens up the historical origin and development of four methods of flying through the air.

Objective To analyze the effect of Huashi Xingyu Qingre decoction therapy through identification of the differentially expressed saliva proteins of oral lichen planus. Method The saliva of OLP patients before and after treatment were collected. Total saliva proteins were extracted. The differentially expressed saliva proteins were screened by two-dimensional fluorescence difference gel electrophoresis and identified by liquid chromatography-mass spectrometry. The differentially expressed proteins were analyzed by Western-blot. Results Six differentially expressed proteins were identified as salivary amylase, serum albumin, IgM, carbonic anhydrase VI, zinc-α2- glycoprote and sIgA. The expression level of serum albumin, IgM, carbonic anhydrase VI and zinc-α2-glycoprotein after treatment were lower than that before. However, the expression level of sIgA was higher. The differences were statistically significant. Conclusions Some differentially expressed saliva proteins of OLP before and after Huashi Xingyu Qingre decoction therapy are characterized, and they may play a vital part in the occurrence and development of OLP.

As one of the cornerstones of modern cardiopulmonary resuscitation (CPR), ventilation received controversy and challenges in the past two decades. From 2000 to 2015, the changes in CPR guidelines of American Heart Association (AHA) showed that the position of ventilation declined gradually as compared to chest compressions. Chest compressions only CPR has been strongly advocated in recent years, especially in witnessed cardiogenic cardiac arrest (CA). Passive oxygenation and cardiocerebral resuscitation (CCR) also showed good effect in the early stage of cardiogenic CA. However, clinical validation in a larger context is still needed. An impedance threshold device (ITD) transiently blocks air from entering the lungs during recoil, decreases the intrathoracic pressure, facilitates venous return to the chest and increases coronary blood flow. However, the relevant research findings are not consistent, and the guidelines do not recommend routine use of ITD. Positive-pressure ventilation, which can increases intrathoracic pressure, affects the coronary perfusion pressure (CPP) and cerebral perfusion, is thought to be not only useless, but also has adverse effects within the first few minutes of CPR. This view is accepted by many scholars, however, ventilation is essential in late-start CPR, prolonged CPR and non-cardiogenic CA. Mechanical ventilation, especially special ventilation modes for CPR showed some prospects. Positive-pressure ventilation remains the gold standard in CPR in clinical practice at present. It was shown by existing research that hyperventilation significantly reduce the success rate of resuscitation, thus a consensus had been reached about avoiding hyperventilation. Currently, the number of studies on ventilation during CPR is very limited, and many of the conclusions are not consistent among studies. Therefore, more high-quality studies are needed in future to further clarify the application of ventilation during CPR.