During recent years,International Nephrology and Emergency Medicine Association preferred a cute kidney injury( AKI)rather than a cute renal failure for the diagnosis and intervention in the early phase of AKI,with the ultimate goal of reducing the mortality rate.It is not sensitive to diagnose AKI in the early phase only according to the change of urine output and serum ereatinine.It is reported that some new biomarkers are sensitive and specific and may play important roles for the early diagnosis of AKI.

Mycophenolate mofetil is a new type immunosupperssor. It has the function of the selective immune suppression and reducing T,B lymphocyte proliferation. Now it is widely used in organ transplantation, immune disease and primary glomerular disease. In this paper,the research results of mycophenolate mofetil for children with kidney disease are summarized.

Objective:To summarize the characteristics of methylmalonic acidemia(MMA) with thrombotic microangiopathy as the prominent manifestation.Methods:Clinical data was collected from MMA patients with thrombotic microangiopathy as the prominent manifestation, who were treated at Shengjing Hospital of China Medical University from September 2014 to December 2019.The clinical manifestations, laboratory results, imaging results, histopathological examination, treatment and prognosis were analyzed.Results:Six children aged 1 month to 7 years old were included in our study, including 5 males and 1 female.Six cases were all MMA complicated hyperhomocysteinemia.All patients had a history of prodromal infection before admission.All cases had edema.Five patients were hypertenson and 4 patients accompanied neurologic presentation.One patient had a family history.All patients were treated with Vitamin B 12, levocarnitine, folic acid and betaine.Three patients′ psychiatric symptoms and renal function were improved and hemolysis were controlled.Two of them were similar with the same age children in intelligence and motor development, with normal renal function, good blood pressure control and normal urine protein.The third one was significantly improved in intelligence development, but still slightly worse than that of the children with the same age.He had no convulsions occurred in recent one year with antiepileptic drugs in oral.His blood pressure was maintained between 135/90-160/110 mmHg(1 mmHg=0.133 kPa), 24-hour urine volume was about 2 000 mL, creatinine was maintained at about 150 μmol/L, ionic level was normal, and urinary protein was 2 + .One case discharged from hospital.Two patients died of multiple organ failure. Conclusion:An early screening of metabolic diseases should be achieved for thrombotic microangiopathy of unknown etiology.Early screening of homocysteine is important for early detection and treatment.

Objective Medical statistics is an important tool in scientific research and practice.The article was to evaluate the current knowledge, learning needs and related influencing factors of medical statistics among medical doctoral students to provide references for the optimization in the teaching mode of medical statistics. Methods A questionnaire was used to investigate Grade 2014 doctoral students who took medical statistics course before and after the teaching in a medical university. Results The knowl-edge of doctoral students were at different levels and they had different learning requirements.More than 81.4% of the respondents have difficulty in the choice of scientific and reasonable design and the scientific design.Over 50%students had insufficient knowledge of advanced statistics and poor software application ability.They had the demands for more practical cases explanation in theory course, more software teaching hours and some short term specialized courses. Conclusion The university and teachers should carry out teaching reform according to the particularity of doctoral students and teach in small sections according to their knowledge levels of sta-tistics and learning requirements.It is suggested that the teaching should be combined with the students'own research projects in order to improve the teaching effect and improve the students'ability in sta-tistical design and solving the practical problem in scientific research statistics.

Objective: To investigate the effect of oxidized low-density lipoprotein (ox-LDL) on expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), transforming growth factor beta 1 (TGF-β 1), and secretion of extracelluar matrix (ECM) in cultured rat glomerular mesangial cells (GMCs), and to investigate the influence of LOX-1 inhibitor polyinosinic acid (PIA) on the effect of ox-LDL. Methods: Rat glomerular masengial cells were cultured in vitro. RT-PCR was employed to determine the LOX-1 mRNA expression in GMCs incubated with different concentrations of ox-LDL (0, 25, 50, 100 μg/ ml). The expression of LOX-1 and TGF-β1, mRNA was also determined by RT-PCR in the blank control group, ox-LDL (50 μg/ml) group and PIA(50 μg/ml ox-LDL+250 μg/ml PIA) group. The contents of TGF-β1 fibronectin (FN), and collagen IV (Col IV) in the supernatants of the above 3 groups were determined by ELISA. Results: RT-PCR showed that LOX-1 mRNA expression in 25, 50 and 100 μg/ml ox - LDL groups was significantly higher than that of blank control group(P<0.05), with the highest expression found in the 50 μg/ml ox-LDL group; the expression of LOX-I and TGF-β 1 mRNA was significantly higher in 50 μg/ml ox-LDL group than that in the other 2 groups (P< 0.01). ELISA results demonstrated that the supernatant contents of TGF-β1, FN and Col IV were significantly higher in 50 μg/ml ox-LDL group than those in the other 2 groups (P< 0.05). Conclusion: Ox-LDL can upregulate the expression of LOX-1 and TGF-β1, mRNA and the secretion of extracelluar matrix in GMCs. Polyinosinic acid can antagonize the above effect of ox-LDL, suggesting that LOX-1 may participate in ox-LDL-induced GMCs damage and is involved in the development and progression of glomerulosclerosis.

Objective To observe the changes of neutrophil gelatinase associated lipocalin,NGAL after endoplasmic reticulum stress by thapsigargin in renal tubular epithelial cells.Methods The renal tubular epithelial cells were treated with thapsigargin to establish the model of endoplasmic reticulum stress (ER group).CHOP and GRP78 expression were detected by Western-blot to confirm endoplasmic reticulum stress in renal tubular epithelial cells by thapsigargin.NGAL expression were detected by Western-blot in ER group and control group(normal renal tubular epithelial cells).Results After treated with 2.5 μmol/L and 5 μmol/L thapsigargin for 4 hours and 8 hours respectively,endoplasmic reticulum stress in the renal tubular epithelial cells were significantly increased comparing with control group (0.585 ± 0.045 to 0.523 ± 0.030;0.785 ± 0.049 to 0.728 ± 0.064),which was approved by the increased expression of CHOP and GRP78 (P ＜ 0.05).The expression of NGAL was significantly increased in ER group (0.567 ± 0.024 to 0.826 ± 0.057,P ＜ 0.05) and it was corresponded with the changes of CHOP and GRP78,which increased significantly with the severity of endoplasmic reticulum stress.Conclusion Endoplasmic reticulum stress can be induced by thapsigargin in renal tubular epithelial cells.The expression of CHOP,GRP78 and NGAL were significantly increased correspondingly with the severity of endoplasmic reticulum stress.It is speculated that the expression of NGAL may be related with endoplasmic reticulum stress in tubular epithelial cells.

Objective To explore the effect of peritoneal dialysis to treat renal failure in children.Methods There were 11 admitted patients of renal failure in our department from July 2003 to April 2008.Their clinical data and follow-up results were analyzed.Results No patient was dead during treatment.The average time of peritoneal dialysis treatment in the children with acute renal failure was 15.5 days in hospital,which was 22.8 days in the chronic patients.After treatment the levels of serum nitrogen and creatine were decreased significantly from (34.03±8.44)mmol/L and (710.09±167.54)μmol/L to (15.94±4.93)mmol/L and (233.87±92.71)μmol/L (P＜0.01).The serum sodium and bicarbonate ion were increased from (130.91±9.15)mmol/L and (14.56±2.07)mmol/L to (139.46±3.98)mmol/L and (22.47±3.29)mmol/L (P＜0.05,P＜0.01).The duration of follow-up were from one month to 5 years.The level of serum nitrogen and creatine in 5 patients of acute renal failure were normal and the analysis of urine was also normal during follow-up.One patient had renal transplantation after peritoneal dialysis.Three patients still regularly underwent peritoneal dialysis.Conclusion The peritoneal dialysis combining with multi-modality treatment was the better style of renal replacement therapy in renal failure patients.

Objective To investigate the expression of β-arrestin2 and microtubule-associated pro-tein light chain(LC)3 in renal of rat with acute renal ischemia reperfusion injury,and to analyze the relation-ship between them and renal injury. Methods Fifty-four male SD rat(3-4 weeks old) were randomly divid-ed into three groups:control group,sham group,acute ischemic reperfusion injury group. We established the acute renal ischemia reperfusion injury model through removing the right kidney and clamping the left renal for 45 minutes with noninvasive arterial clip. We obtained the kidney and blood samples respectively at 12 h, 24 h,36 h,48 h,72 h,96 h after the surgery. Expressions ofβ-arrestin2 and LC3 protein were detected by the immunohistochemistry method and Western blot method. The renal function and morphological changes were assessed. Results Compared with control group and sham group,the serum creatinine and kidney pathologi-cal grading of acute ischemia reperfusion injury group obviously rised. The kidney injury was the most serious at the 24 h after acute ischemic reperfusion injury. The expressions of β-arrestin2 and LC3 were little in the control group and sham group. However,the expressions of these two indicators were obviously higher and reached the peak at the 12 h after acute ischemia reperfusion injury. All these results suggested that the chan-ges of these two indicators were anterior to the histopathological changes. The expressions ofβ-arrestin 2 and LC3 protein were in positive correlation with the kidney injury(r=0. 821,P<0. 05;r=0. 913,P<0. 05). Conclusion In the acute renal ischemia-reperfusion injury,β-arrestin2 may be as a kind of upstream regula-tory protein involving in the kidney pathological process through the regulation of the autophagy.

Objective To determine the effect of passive smoking during pregnancy on the expression of tumor necrosis factor-? (TNF-?) and cytokine-induced neutrophil chemoattractant (CINC) in the lungs of neonatal rats. Methods Sprague Dawley rats were exposed to sidestream cigarette smoke on the 1, 8 and 15 day after pregnancy for a total of 2 h each day. Those rats who were put into the box without smoke exposure were as control. The neonatal rats were delivered by cesarean section on the 20th day of gestation and birth weight was measured. Reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunoadsorbent assay (ELISA) was performed to evaluate the expression of TNF-?、CINC mRNAs and TNF-? protein. Results The birth weight of neonatal rats born from those mothers who were exposed to sidestream cigarette smoke was significantly lower than that of control gruop(P