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 study the relationship between renal morphology and renal function,and to assess the value of CT as a criterion to grade renal function.Methods Enhancement CT were performed in 89 patients with no local renal disease whose split renal glomerular filtration rates(GFR)were measured by renal dynamic imaging with ~(99)Tc~m-DTPA.The 178 kidneys were divided into normal renal function,mild and severe renal impairment groups according to renal function.Differences between three groups respect to the mean thickness of renal cortex and parenchyma were assessed by ANOVA.Using Pearson's correlation test,the correlation between the renal cortex,parenchyma thicknesses and renal GFR were examined.The value of CT in predicting renal function was assessed by using ROC analysis.Results The renal cortex thicknesses of normal renal function,mild and severe renal impairment groups were(5.9?1.1),(4.6? 1.1),and(3.3?1.0)mm respectively,and the renal parenchyma thicknesses were(26.3?4.2), (21.3?4.6),(16.2?4.6)mm.There were significant differences of renal cortex,parenchyma thicknesses between 3 groups(cortex F=54.78,P

AIM: To observe the comparison of vitrectomy combined drug therapy ( Ranibizumab injection ) and single vitrectomy for proliferatived diabetic retinopathy ( PDR ) and the influence of the curative effect and prognosis of patients.
METHODS:In this study, 112 cases (125 eyes) with PDR were selected and randomly divided into experimental group and control group ( n= 56 ) . Fifty-six cases ( 61 eyes ) in experimental group were injected by drug therapy of 0. 5mg ranibizumab and received vitrectomy;In control group, 56 cases ( 64 eyes ) were received single vitrectomy. The intraoperative and postoperative differences of clinical indicators were analyzed in two groups.
RESULTS: The average operation time, intraoperative electric coagulation hemostasis rate and iatrogenic hiatal incidence of the experimental group were lower than that of the control group:(95. 00±13. 00) min vs (133. 00±14.5) min, 11% vs 34%, 5% vs 20%, respectively (P<0. 05). The anterior chamber and vitreous body cavity hemorrhage rate within postoperative 1mo in the experimental group were lower than that of the control group:7% vs 23%, 5% vs 12%, respectively (P<0. 05). The postoperative visual acuity of experimental group was better than that of the control group:0. 375±0. 210 vs 0. 261±0. 170, respectively (P<0. 05).
CONCLUSION: Patients with PDR injected with ranibizumab in vitreous cavity before vitrectomy can effectively reduce the operation time, less intraoperative blood loss, the incidence of iatrogenic hiatus, and intraoperative and postoperative complications. The postoperative visual acuity was better than before.

Objective To explore the changes of Sema3A and it′s receptor Npl in temporal lobe epilepsy(TLE)rat brain and the roles in epileptogenesis mechanism.Methods TLE model was established with male healthy SD rats,in which mossy fiber sprouting(MFS)was verified using Neo-Timm staining method.Sema3A mRNA,Npl mRNA and protein was respectively analyzed by immunohistochemistry and in situ hybridization in the entorhinal cortex(EC)or dentate gyrus(DG)at different time after LiCL-PILO induced TLE.Results There were Mossy fiber sprouting(7d:0.70?0.42,15d:1.50?0.52,30 d:2.20 ?0.41,60 d:2.50?0.51)in DG inner molecular layer(IML)of TLE rat compared with those of controls (P

Objective To summarize the clinical experiences of mini-incision urological surgery.Methods The clinical data of 43 patients who received mini-incision surgery were reviewed retrospectively.The subjects included 5 adrenal tumor excisions,9 nephrectomy,13 unroofing of solitary renal cyst,4 pyeloplasty.12 pyelolithotomy and ureterolithotomy.Results All surgical procedures were successful in the 43 cases.The length of the incision ranged from 3 to 8 cm.The average operation time was 80 minutes and average blood loss was 100 ml. No patients needed blood transfusion during the operation.No serious complications such as the surrounding organ damage happened.The postoperative hospitalization was 5-7 d. Conclusion Mini-incision approach for urological operation has the advantages of minimal invasion,safety,rapid recovery and no requirement for special equipments.Its easy to be popularized in the primary hospital.

Objectives To investigate the correlation between single nucleotide polymorphisms (SNP) in interleu-kin-15 (IL-15) and treatment response in childhood acute lymphoblastic leukemia (ALL). Methods Genomic DNA samples extracted from remission bone marrow cells of ALL patients were genotyped by MassArray. Five SNPs (rs10519612, rs10519613, rs17007695, rs17015014 and rs35964658) in IL-15 and their association to minimal residual disease (MRD) status in the end of induction therapy were studied. Results SNP rs17007695 was associated with the early response in children with ALL(P=0.049) and the incidence of positive MRD after induction therapy in CC genotype carriers was 1.8 times more than that in TT genotype carriers. Haplotype analysis of these five SNPs showed that the frequency of haplotype CACGG in MRD positive group was 2.1 times higher than that in MRD negative group (P=0.035). Conclusions IL-15 gene polymorphism was associated with the early treatment response in Han Chinese children with acute lymphoblastic leuke-mia.

From the aspects of strengths,weaknesses,opportunities and threats,this paper analyzed external factors of the reorganizations and group building reform of public hospitals in Shanghai.Points made are as follows:Characteristics of individual hospitals should he respected instead of a generalized pattern for all;the role of the government to play in this regard should he guidance of an orderly competition,Strengthen Supervision,and promotion of the reform in property rights,These efforts will create a desirable environment for hospital groups;mid- and long-term goals for the reform should consolidate the independent legal entity status of such groups.

Objective To investigate the effects of CO_2 pneumoperitoneum on the expression of focal adhesion kinase (FAK) of gastric cancer MKN-45 cells. Methods CO_2 pneumoperitoneum with different pressures was simulated in vitro, and the gastric cancer MKN-45 cells were divided into test and control groups. In the test group, gastric cancer MKN-45 cells were cultured in CO_2 pneumoperitoneum with different pressures [5, 10 or 15 mm Hg (1 mm Hg =0.133 kPa)] for 4 hours. The condition of the cells exposed to CO_2 pneumoperitoneum with a pressure of 15 mm Hg was observed at 0.5, 2 and 4 hours. Gastric cancer MKN-45 cells in control group were cultured at normal atmospheric pressure. The expression of FAK and phosphorylated FAK (FAK Tyr397) of each group was detected by Western blot. Multiple-group analysis was done by one-way ANOVA, and intergroup comparison was done by LSD test. Results In CO_2 pneumoperitoneum with pressures of 5, 10, 15 mm Hg, the expression of FAK was 2.14±0.17, 2.07±0.21 and 2.52±0.26, respectively, and the expression of FAK Tyr397 was 1.82±0.28, 1.93±0.52 and 3.71±0.37, respectively. The expression of FAK and FAK Tyr397 in the control group was 2.43±0.46 and 1.71±0.23, respectively. We found significant differences between the 2 groups (F = 2.171, 26.951, P < 0.01). After gastric cancer MKN-45 cells being treated for 0.5, 2 and 4 hours in CO_2 pneumoperitoneum with a pressure of 15 mm Hg, the expression of FAK Tyr397 was 3.41±0.44, 4.12±0.56 and 5.24±0.41 respectively, which is also significantly different (F =116.119, P < 0.01). The expression of FAK Tyr397 was back to 0.72±0.16 1 hour after the release of CO_2. Conclusions CO_2 pneumoperitoneum with different pressures can not promote the expression of FAK in gastric cancer MKN-45 cells which had been cultured for 4 hours, but can activate FAK through promoting its phosphorylation. The degree of FAK phosphorylation increases with pressure and time, and the activity of FAK decreases to pretreatment level rapidly once pressure is released.

Objective To evaluate the therapeutic efficacy of ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi. Methods Clinical data of 56 cases with complicated ureteral calculi who were treated with ureteroscopic pneumatic lithotripsy was reviewed. Among them 15 cases were proximal ureteral calculi,41 cases were middle and distal ureteral calculi. Treatment by extracorporeal shockwave lithotripsy (ESWL) failed in 25 cases,8 cases complicated with fever. Results In 41 cases with middle and distal ureteral calculi, successful lithotripsy was achieved after the first treatment session,the success rate was 100.0% (41/41). In 15 cases with proximal ureteral calculi ,successful lithotripsy was achieved in 10 cases after the first treatment session,the success rate was 66.7%(l0/15). Calculi migrated to kidney in 3 cases who treated by ESWL for 1-2 times. The failure was due to ureteral kink in 1 case and due to ureteral perforation that required surgical repair in another case. Forty-nine cases were calculi-free after 4 weeks,the calculi-free rate was 87.5%(49/56). Emergency operation was performed in 8 cases complicated with fever. Successful lithotripsy was achieved after the first treatment session in 7 cases. In one patient,calculi migration occurred. Within all 8 cases obstruction was released and fever was allayed after operation.The complication rate was 1.8% (1/56). Conclusion Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi is a safe and effective method.

Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in preoperative diagnosis of anal fistula. Methods Forty-five patients with fistula in ano were evaluated by physical examination, then CEUS were peformed by injecting SonoVue through the external opening to enhance the detection of the fistulous track and the internal opening. The results of CEUS were matched with surgical features to establish their accuracy in preoperative assessment of anal fistula. Results Simple typing fistula was found in 19 of 45 patients and 26 patients had complex fistulas. The accurate diagnostic rates by conventional ultrasound of simple typing fistula and complex fistulas were 89. 5% and 61.5%,respectively,the accurate diagnostic rates by CEUS of simple typing fistula and complex fistulas were 94. 7% and 92.3%, respectively, there was no significant difference between conventional ultrasound and CEUS about simple typing fistula( P ＞0.05), and there was significant difference about complex fistulas ( P ＜0. 05). Conclusions CEUS has a good visibility and accurate rate for diagnosis of anal fistula,It plays an important role for operation.