Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis.Methods A total of 141 eligible patients were enrolled in this prospective study.Blood and urine samples were collected at different time points as soon as sepsis was diagnosed.The concentrations of serum creatinine (Scr),urine sTREM-1 and NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,urine sTREM-1 and NGAL were observed in two groups.The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL.Results Among 141 septic patients,44 (31.2％) cases had concomitant AKI.Twenty four hours after sepsis diagnosed,the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6± 15.3) μmol/L,P ＜ 0.05],which met the diagnostic criteria of AKI.In the AKI group,urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9± 14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L,both P ＜ 0.05].And at the following time points,urinary concentrations of sTREM-1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P ＜ 0.05).At 8 h time point,thearea under the curve of urine sTREM-1 was 0.877 (95％CI 0.756-0.914),the sensitivity was 89.1％ and specificity was 82.0％ with a cutoff value of 70 ng/L.At 8 h time point,the area under the curve of urine NGAL was 0.862 (95％ CI 0.703-0.958),the sensitivity was 87.4％ and specificity was 85.5％ with a cutoff value of 90 μg/L.Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr.Therefore,urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.

Objective To evaluate prognostic significance of early lactate clearance rate for cardiogenic shock patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-seven patients with cardiogenic shock supported by venoarterial ECMO were prospectively enrolled from May 2010 to May 2013.Arterial blood lactate at pre-ECMO support(0 h),at post-ECMO 6 hours(6 h) were measured and then 6 h lactate clearance rate was calculated.90 days after admission was the endpoint of research.Patients were divided into the survival group(n =25) and the death group(n =22).6 h lactate clearance rate was compared between groups.The 6 h lactate clearance rate for predicting death was evaluated by receiver operating characteristic(ROC) curves.The surviving curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.Factors influencing the prognosis were analyzed by applying the multiplelogistic regression analysis.Results The 6 h lactate clearance rate was higher in survivors than in nonsurvivors [(38.6 ± 15.1) ％ vs.(14.4 ± 13.8) ％,P ＜ 0.05].The area under the ROC curve of 6 h lactate clearance rate for predicting death was 0.869 ± 0.075 (95％ CI:0.753-0.991).The best cutoff point was 20.0％ with a sensitivity of 92.0％ and specificity of 85.0％.KaplanMeier survival analysis showed that 90 days survival rate of high lactate clearance rate group and low lactate clearance rate group were 66.7％ and 35.0％,with significant difference between the two groups(Log-rank test,P ＜ 0.05).Multivariate logistic regression analysis showed that 6 h lactate clearance rate (OR =3.156,95 ％ CI:2.326-7.253,P ＜ 0.05) was one of the independent risk factors associated with mortality of patients on ECMO.Conclusion Early lactate clearance rate could be used as an important maker for evaluating the prognosis of cardiogenic shock patients on ECMO.

BACKGROUND:The surface antigen CD80/CD86 on mature dendritic cells can activate helper T (Th) cells, reduce the differentiation of Th cells toward Th1 cells, and promote the differentiation of Th cells toward Th2 cells.
OBJECTIVE:To investigate the effect of smal interfering RNA (siRNA) inhibiting the expression of surface antigens CD80/CD86 from asthmatic murine mature dendritic cells on Th1/Th2 type cytokines, interferon-γand interleukin-4.
METHODS:Asthmatic model of mice was established;then bone marrow-derived mature dendritic cells were separated and cultured. The expression of CD11c, CD80 and CD86 on mature dendritic cells were examined by flow cytometry. The siRNA was transferred into mature dendritic cells of asthmatic mice, and the CD80/CD86 mRNA and protein expression before and after interference were determined by fluorescent quantitative PCR and flow cytometry. The mature dendritic cells in non-siRNA group, siRNA group and negative siRNA group were co-cultured with T cells. The interferon-γand interleukin-4 productions were measured by enzyme-linked immunosorbent assay.
RESULTS AND CONCLUSION:(1) The expression of CD80/CD86 on the mature dendritic cells of asthmatic group was significantly higher than that in normal control group (al P<0.05). (2) After siRNA was transferred into mature dendritic cells, the expression level of CD80/CD86 mRNA and protein in siRNA group was significantly lower than other groups (al P<0.05). (3) After siRNA transfection, the level of interferon-γfrom the supernatant of mature dendritic cells and T cells co-culture system was significantly increased in the siRNA group compared with other groups (al P<0.05), while interleukin-4 production in the siRNA group was significantly decreased (al P<0.05). These findings suggest that high expression of CD80/CD86 on mature dendritic cells of asthmatic mice is observed, specific siRNA can effectively inhibit the expression of CD80/CD86, thus increasing interferon-γproduction and decreasing interleukin-4 production, which contributes to regulate the Th1/Th2 imbalance.

OBJECTIVE:To investigate the possible association between the gene ALOX5AP encoding 5-lipoxygenase activating protein (FLAP)and coronary artery disease(CAD)in the Han population of North China.METHODS:A total of 680 cases underwent selective coronary angiography(SCA)from Shenyang General Hospital of Chinese PLA was recruited from January 2006 to September 2007.According to the results of SCA.680 cases were divided into CAD group with angiography positive(n=336)and control group with angiography negative or the stenosis of coronary arteries<50%(n=344)without evidence of cardiac ischemia.Single nucleotide polymorphisms of ALOX5AP gene was screened in 48 unrelated Han individuals of North China by polymerase chain reaction fPCR)-Re-sequencing method and 7 polymorphisms were found.The genotype and allele distribution of T(-1340)G polymorphism between two groups was determined by polymerase chain reaction and restriction fragment Iength polymorphism(PCR-RFLP)analysis in CAD and controI subjects.RESULTS:The genotype frequencies of TT,TG and GG in the ALOX5AP T(-1 340)G polymorphism were 26.79%,51 179%and 21.43%in CAD patients,33.72%,47.38%and 18.90%in the controls,respectively(x~2=3.90,P>0.06).The genotype distribution between two groups was in accordance with hardy-weinberg equilibrium.There are no significant differences in the distribution of three genotypes between the two groups.The frequencies of ALOX5AP G allele in cases and controls were 47.32%,42.59%,respectively(x~2=3.08,P>0.05).Subsequent stratified analysis by gender also showed no statistical significance in the genotype frequencies and allele frequencies between the two groups.CONCLUSION:The result suggests that T(-1340)G polymorphism of the ALOX5AP gene might not be associated with CAD in the Han population of North China.

Objective To investigate the biological effects of 12C heavy ions with different LETs,and to construct the dose-effect curves of chromosomal aberrations and micronucleus.Methods Human peripheral blood lymphocytes were irradiated with 0.5 - 5.0 Gy of 60Co γ-rays,29 and 148 keV/μm 12C with a dose rate of 0.5 Gy/min,respectively.The colchicine method and cytokinesis-blocking method were applied to measure chromosome aberrations and micronuclei formation,respectively. Results The chromosomal aberrations induced by 29 and 148 keV/μm of 12C ion had a linear dose response,while the dose-response of micronucleus induction followed to a linear-quadratic model.Chromosome aberration and micronucleus frequency increased with the LET of 12C ions. However, the micronucleus frequency increased slowly when the radiation doses exceeded 3.0 Gy..Chromosomal aberrations induced by 148 keV/μm 12C ions increased significantly when the time of colchicine treatment was prolonged.Conclusions Chromosome aberration and micronucleus induced by 12C ions increased with the LET,and the micronucleus frequency increased with dose less than 3 Gy.The biological effects of 12C ions were stronger than those of low LET irradiation of γ-rays.

Objective To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock.Methods Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output(PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline,after PLR,and after volume expansion.Fluid responsiveness was defined as an increase in cardiac index (CI) of 15％ or greater after volume expansion.The correlation between PLR-induced CI change (△CIPLR) and PETCO2 (△PETCO2-PLR) was analyzed.The value of △PETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves.Results A total of 42 patients were enrolled in this study,of whom,24 had a CI increase of ≥ 15％ after volume expansion (responders).After PLR,CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9) ％ of CI and (9.6 ± 4.7) ％ of PETCO2,P ＜ 0.05],while no significant changes were observed (P ＞ 0.05) in the non-response group.Both △CIPLR and △PETCO2-PLR were significantly higher in responder group than in the non-responder group (both P ＜ 0.05).△CI and △PETCO2 after PLR were strongly correlated (r =0.64,P ＜ 0.05).In responders after PLR,the area under ROC curve of △PETCO2-PLR was 0.900 ± 0.056 (95％ CI 0.775-1.000,P ＜ 0.05).An increase of ≥ 5％ in △PETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0％ and specificity of 88.2％.Conclusions The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.

Objective To evaluate the efficacy of rituximab-containing regimens on post-transplantation lymphoproliferative disorder (PTLD) following haploidentical hematopoietic stem cell transplantation (HSCT). Methods The clinical data of 3 cases of PTLD after haploidentical HSCT were analyzed retrospectively. Time to development of PTLD ranged from 57 to 164 days after HSCT.The main symptoms included fever, superficial lymph node enlargement. Epstein-Bart virus (EBV)-positive B-cell PTLD was diagnosed by biopsy of lymph node. Management of 3 patients consisted of withdraw of immunosuppressive treatment, anti-viral therapy, rituximab (375 rng/m2 , per week for four weeks) monotherapy or chemotherapy plus rituximab. Results All the patients had complete remission after treatment. Conclusion PTLD is a serious complication of HSCT especially haploidentical HSCT. Rituximab-containing regimens are potentially effective, well-tolerated with mild toxicity and improve the prognosis of PTLD following haploidentical HSCT.

OBJECTIVETo analyze the cause of atypical manifestation of hepatocellular carcinoma (HCC) in triple-phase spiral CT enhanced scan.

METHODSTriple-phase spiral CT scan was performed in 75 patients with HCC. The hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) images were started at 25 to 30 s, 65 to 70 s and 3 tp 5 min after injection of contrast medium. The contrast enhanced patterns of lesion were observed and analyzed.

RESULTSNinety-two lesions were found in 75 patients. Typical enhanced findings such as hyperdense in HAP and hypodense in PVP and DP was found in 60 of 92 lesions. Atypical enhanced findings were observed in the other 32 lesions. Fourteen of 32 atypical enhanced lesions were hyperdense in HAP and isodense in PVP, of which 8 were seen in liver cirrhosis and 3 in fatty liver. In DP, 10 were hypodense and 4 still isodense. Eight of the 32 lesions were hyperdense both in HAP and PVP, of which 6 were seen in fatty liver. In DP, 3 were isodense and 5 were hypodense. Six of 32 lesions were isodense in HAP which became hypodense in PVP and DP. Four of 32 lesions were all hypodense in HAP, PVP and DP.

CONCLUSIONMultiple atypical enhanced manifestations are present by triple-phase spiral CT scan in HCC. Pattern of blood supply, scanning technique and pathophysiologic status are usually the cause of these findings.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; Contrast Media ; Humans ; Liver Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND:Spinocerebel ar ataxia is a inherited neurodegenerative disease with progressive cerebel ar masonic movement disorders as the main clinical manifestation. So far, no drug is available to control the disease progression. OBJECTIVE:To observe the clinical effect of umbilical cord mesenchymal stem cells in treating spinocerebel ar ataxia by intrathecal injection. METHODS:Thirty-eight cases of spinocerebel ar ataxia were given umbilical cord mesenchymal stem cells by intrathecal injection, 1×106/kg once a week, four times as a course. These 38 cases received 52 courses. Among them, 27 cases received 1 course, 8 cases received 2 courses and 3 cases received 3 courses. International Cooperative Ataxia Rating Scale (ICARS) and Activity of Daily Living Scale (ADL) were used to evaluate patients’ neural functions (the greater scores, the more severe damage) and ability of daily living (the lower score, the stronger the ability of daily living). After treatment, al patients were subjected to fol ow-up visit. RESULTS AND CONCLUSION:The total effective rate of 52 courses of treatment was 84.62%. ICARS and ADL scores were significantly decreased at 1 month after treatment (P<0.01). In most of effective patients, unstable walking and standing, slow movement, upper limb fine motor disorder, writing difficulties, dysarthria, eye movement disorders were improved. After treatment, common adverse effects were dizziness (1 case), low back pain (2 cases), headache (1 case), and fever (2 cases). Al these symptoms disappeared within 1-3 days. No treatment-related adverse events happened in the median fol ow-up of 39 months (11-59 months). The il ness of effective patients had been stable for 1-19 months, average (5.95±4.84) months. Intrathecal injection of umbilical cord mesenchymal stem cells is safe to ameliorate clinical symptoms to some extent within a certain time. It may delay the progression of spinocerebel ar ataxia. Multiple courses of treatment can help to further improve neurological function in most patients.