Acute kidney injury (AKI) is one of the most common complications in critically ill patients, and sepsis is the main cause of AKI in the intensive care unit (ICU), which can lead to a poor prognosis in severe cases. For patients with sepsis-associated acute kidney injury (SA-AKI) for whom urgent dialysis is indicated, it is now clear that renal replacement therapy (RRT) can be initiated immediately to control disease progression. However, the optimal timing to initiate RRT in patients whose disease is not severe enough to warrant urgent dialysis remains controversial. Some previous studies were small and heterogeneous, and there was a lack of effective reference indicators for guiding RRT in SA-AKI patients. Therefore, this article reviews the relevant experimental studies on the treatment of critically ill patients with AKI in recent years, and reviews the latest research progress on the optimal timing of RRT initiation, in order to provide an effective reference for clinical practice.
Humans ; Acute Kidney Injury/etiology* ; Renal Replacement Therapy/methods* ; Sepsis/therapy* ; Time Factors ; Intensive Care Units

[Purpose]To analyze the evolution of equity in the distribution of oncology bed re-sources across China from 2012 to 2021.[Methods]Based on data from the China Health and Family Planning Statistical Yearbook and the China Health Statistical Yearbook from 2012 to 2021,descriptive statistical analysis and the Theil index decomposition method were employed.The analysis focused on disparities in oncology bed distribution across 31 provinces,measured from a population-based equity perspective.Specifically,the Theil index was decomposed to quan-tify inter-regional(between Eastern,Central,Western China)and intra-regional disparities and their respective contribution rates.[Results]The total number of oncology beds in China in-creased by 78.54％between 2012 and 2021.The overall Theil index decreased from 0.048 9 in 2012 to 0.041 6 in 2021,indicating a continuous improvement in equity of distribution based on population.Intra-regional disparities were the predominant source of the total disparity,with an average contribution rate exceeding 60％.The Eastern region exhibited the highest level of intra-regional disparity,whereas the Central region had the smallest and most stable intra-regional dis-parity.[Conclusion]Targeted measures are recommended,including strengthening government-led development of regional oncology medical centers,facilitating the transfer of quality oncology resources to grassroots levels,and improving basic-level oncology service facilities.These efforts should focus on narrowing the disparities in oncology resource allocation between Eastern,Cen-tral,and Western China to promote more balanced development.

Objective To explore the effect of exenatide on oxidative stress in the hypothalamus of diabetes mice and its potential mechanism.Methods After one week of adaptive feeding,C57BL/6J mice were randomly divided into the CON group(normal chaw diet),the T2DM group(high-fat diet,HFD),and the T2DM+Exe group(HFD+exenatide).After 8 weeks of HFD,mice in the T2DM+Exe group were intraperitoneally injected with exenatide[24 nmol/(kg·d)]for 8 weeks.The weight and glucose and lipid metabolism levels of the mice were measured,and the levels of inflammatory and adipokine factors in mice were detected using the ELISA method.Western Blot was used to detect the expression of melanocortin receptor-4(MC4R)and proopiomelanocor-tin(POMC)in the hypothalamus.Hypothalamic mitochondria were extracted,and the content of mitochondrial reactive oxygen species(ROS)was measured using a flow cytometer.The content of malondialdehyde(MDA)and the activities of superoxide dismutase(SOD)in the mitochondria were detected using assay kits.Changes in the ultrastructure of mitochondria were observed using a transmission electron microscope.In vitro experiments,pal-mitic acid(PA)and exenatide were used to treat hypothalamic GT1-7 cells,and short hairpin RNA(shRNA)was used to silence the melanocortin 4 receptor(MC4R),and observe the cellular oxidative stress and lipid deposition.Results Compared with the CON group,the T2DM group mice showed a significant increase in glucose and lipid metabolism indicators,pro-inflammatory factors,and adipose factor levels(P<0.05),the expression of MC4R and POMC proteins in the hypothalamus were decreased(P<0.05),and the mitochondrial ROS and MDA content in the hypothalamus significantly were increased(P<0.05),while SOD and CAT activities were decreased(P<0.05).Mitochondrial morphology was abnormal.After intervention with exenatide,the above indicators were signifi-cantly improved.After inhibiting MC4R expression in vitro experiments,compared with the intervention group with exenatide,the ROS and MDA content was significantly increased(P<0.05),SOD activity was decreased(P<0.05),and lipid deposition occurred in the cells.Conclusions Exenatide exhibits a protective effect on hypotha-lamic oxidative stress injury in diabetic mice,and this mechanism may be associated with the upregulation of MC4R expression.

Objective To explore the effect of exenatide on oxidative stress in the hypothalamus of diabetes mice and its potential mechanism.Methods After one week of adaptive feeding,C57BL/6J mice were randomly divided into the CON group(normal chaw diet),the T2DM group(high-fat diet,HFD),and the T2DM+Exe group(HFD+exenatide).After 8 weeks of HFD,mice in the T2DM+Exe group were intraperitoneally injected with exenatide[24 nmol/(kg·d)]for 8 weeks.The weight and glucose and lipid metabolism levels of the mice were measured,and the levels of inflammatory and adipokine factors in mice were detected using the ELISA method.Western Blot was used to detect the expression of melanocortin receptor-4(MC4R)and proopiomelanocor-tin(POMC)in the hypothalamus.Hypothalamic mitochondria were extracted,and the content of mitochondrial reactive oxygen species(ROS)was measured using a flow cytometer.The content of malondialdehyde(MDA)and the activities of superoxide dismutase(SOD)in the mitochondria were detected using assay kits.Changes in the ultrastructure of mitochondria were observed using a transmission electron microscope.In vitro experiments,pal-mitic acid(PA)and exenatide were used to treat hypothalamic GT1-7 cells,and short hairpin RNA(shRNA)was used to silence the melanocortin 4 receptor(MC4R),and observe the cellular oxidative stress and lipid deposition.Results Compared with the CON group,the T2DM group mice showed a significant increase in glucose and lipid metabolism indicators,pro-inflammatory factors,and adipose factor levels(P<0.05),the expression of MC4R and POMC proteins in the hypothalamus were decreased(P<0.05),and the mitochondrial ROS and MDA content in the hypothalamus significantly were increased(P<0.05),while SOD and CAT activities were decreased(P<0.05).Mitochondrial morphology was abnormal.After intervention with exenatide,the above indicators were signifi-cantly improved.After inhibiting MC4R expression in vitro experiments,compared with the intervention group with exenatide,the ROS and MDA content was significantly increased(P<0.05),SOD activity was decreased(P<0.05),and lipid deposition occurred in the cells.Conclusions Exenatide exhibits a protective effect on hypotha-lamic oxidative stress injury in diabetic mice,and this mechanism may be associated with the upregulation of MC4R expression.

[Purpose]To analyze the evolution of equity in the distribution of oncology bed re-sources across China from 2012 to 2021.[Methods]Based on data from the China Health and Family Planning Statistical Yearbook and the China Health Statistical Yearbook from 2012 to 2021,descriptive statistical analysis and the Theil index decomposition method were employed.The analysis focused on disparities in oncology bed distribution across 31 provinces,measured from a population-based equity perspective.Specifically,the Theil index was decomposed to quan-tify inter-regional(between Eastern,Central,Western China)and intra-regional disparities and their respective contribution rates.[Results]The total number of oncology beds in China in-creased by 78.54％between 2012 and 2021.The overall Theil index decreased from 0.048 9 in 2012 to 0.041 6 in 2021,indicating a continuous improvement in equity of distribution based on population.Intra-regional disparities were the predominant source of the total disparity,with an average contribution rate exceeding 60％.The Eastern region exhibited the highest level of intra-regional disparity,whereas the Central region had the smallest and most stable intra-regional dis-parity.[Conclusion]Targeted measures are recommended,including strengthening government-led development of regional oncology medical centers,facilitating the transfer of quality oncology resources to grassroots levels,and improving basic-level oncology service facilities.These efforts should focus on narrowing the disparities in oncology resource allocation between Eastern,Cen-tral,and Western China to promote more balanced development.

Objective:To construct a prediction model for ventilator-associated pneumonia (VAP) in mechanically ventilated preterm infants in the neonatal intensive care unit (NICU) and to test its clinical effect.Methods:This was a cross-sectional study. A total of 740 preterm infants admitted to the NICU for mechanical ventilation from July 2018 to June 2023 were retrospectively selected as the study subjects, and were divided into the modeling set (518 cases) and the validation set (222 cases) according to the ratio of 7∶3 using the computer-generated random number method. The modeling set was divided into the VAP group (181 cases) and the non-VAP group (337 cases) according to whether VAP occured, and 21 clinical characteristics were analyzed, using single factor difference analysis to screen predictive factors, the independent risk factors of VAP in mechanically ventilated preterm infants were determined by multivariate Logistic regression analysis, and the nomogram model was made by R software. Then, the nomogram model was tested by validating the data of the validation set. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test, calibration curve and clinical decision curve were used to evaluate the efficacy and practical value of the model.Results:There were 88 males and 93 females in the VAP group, with 156 cases of gestational age<34 weeks and 25 cases of gestational age≥34 weeks. There were 155 males and 182 females in the non-VAP group, with 196 cases of gestational age<34 weeks and 141 cases of gestational age≥34 weeks. Birth weight ( OR=0.114, 95% CI 0.044-0.268, P<0.05) and oral care of breast milk ( OR=0.124, 95% CI 0.0.057-0.249, P<0.05) were protective factors for VAP in mechanically ventilated preterm infants, and Apgar score at 5 min after birth ( OR=2.895, 95% CI 1.318-6.419, P<0.05), serum prealbumin at 72 h of mechanical ventilation ( OR=4.837, 95% CI 2.643-9.063, P<0.05), gastric contents reflux ( OR=6.754, 95% CI 3.156-15.240, P<0.05), and time of mechanical ventilation ( OR=7.784, 95% CI 3.491-18.160, P<0.05) were independent risk factors for VAP in mechanically ventilated preterm infants. The area under the curve (AUC) of the ROC curve of the modeling set was 0.929 (95% CI 0.907-0.950, P<0.01), and the validation set (AUC) was 0.917 (95% CI 0.882-0.952, P<0.01), the model has good discrimination. The C indices of the modeling set and the validation set were 0.93 and 0.92 respectively by sampling 500 times by the Bootstrap method, indicating that the model had good consistency, and the decision curve suggested that the prediction model was far from the extreme curve and the net return value was high, indicating that the nomogram prediction model constructed this time had high prediction value. Conclusions:Birth weight, Apgar score at 5 min after birth, time of mechanical ventilation, oral care of breast milk, serum prealbumin at 72 h of mechanical ventilation, and gastric contents reflux are independent influencing factors for VAP in mechanically ventilated preterm infants. The nomogram prediction model constructed can provide a visual and simple evaluation tool for early identification of high-risk children and reducing the occurrence of VAP.

Objective:To analyze the pathogenicity and clinical characteristics of patients with Cohen syndrome caused by a compound heterozygous variation of VPS13B gene. Methods:A pedigree investigation was conducted.A Chinese Han family with Cohen syndrome was recruited from Henan Eye Hospital in September 2021.There were three members of two generations in this family, including one patient.The clinical data of the proband and his parents were collected, and the relevant ophthalmic and general examinations were performed to evaluate the clinical phenotype.The peripheral venous blood samples of the family members were collected to extract whole genomic DNA, and the whole exome sequencing was performed.Sanger sequencing and pedigree co-segregation analysis were performed among the family members.According to the ACMG guidelines, the pathogenicity of the selected variants was evaluated and the online tools were used to predict the pathogenicity of the variants.Relevant literature of Cohen syndrome were retrieved in Online Mendelian Inheritance in Man (OMIM) and PubMed, China National Knowledge Infrastructure and Wanfang databases by taking Cohen syndrome and VPS13B gene as the searching keywords.The clinical manifestations and pathogenic variants of patients in the literature were summarized, and the relationship between genotype and clinical phenotype was analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[15]). Both the subject and the patient's guardian were aware of the study purpose and method.Written informed consent was obtained. Results:The family was consistent with autosomal recessive inheritance.The proband, a 5-year-old male, had bilateral night blindness with photophobia, ptosis, lower eyelid entropion, and trichiasis; high myopia in both eyes; osteoblastoid pigmentation in the peripheral retina, atrophy and thinning of the outer layer of the peripheral retina, extinguished flashing electroretinogram; global growth retardation, typical facial features, slender fingers and toes, flatfoot, foot valgus, dystonia, no cardiac abnormalities; excessively cheerful personality.The clinical manifestations of the proband were consistent with Cohen syndrome.No obvious abnormality was found in the clinical phenotype and the auxiliary examination of the proband's parents.Whole exon sequencing revealed that the proband carried two heterozygous variations, a nonsense variation c. 11713C>T(p.Gln3905*) and a splicing variation c. 6940+ 1G>T.Sanger sequencing confirmed that the above variations were co-segregated in this family.c.11713C>T(p.Gln3905*) was a novel variant, which prematurely terminated the protein encoded by it and affected the normal function of the protein.The two variations were pathogenic variants according to the ACMG guidelines.A total of 12 articles on variants and clinical characteristics of Cohen syndrome in China were retrieved.Combined with the results of this study, a total of 24 VPS13B variants were found in Chinese patients, of which the incidence of frameshift variation was 41.7%(10/24), missense variation 20.8%(5/24), splicing variation 20.8%(5/24) and nonsense variation 16.7%(4/24), respectively.The onset age of patients with Cohen syndrome was from 28 days to 12 years old.The symptoms such as nerve system, eye, brain, and bone were sporadic, and the clinical manifestations were highly heterogeneous. Conclusions:A novel pathogenic variation c. 11713C>T is found in the VPS13B gene of the Cohen syndrome pedigree in this study, and expands the pathogenic variation spectrum of the VPS13B gene.The clinical manifestations of Cohen syndrome are highly heterogeneous.

Objective Based on the data of scientific research output in a top three hospital in Beijing from 2015 and 2016,stochastic frontier analysis is conducted to estimate the efficiency of scientific research performance in different departments of this hospital,so as to draw the impetus for the growth of departments.Methods According to the results of the stochastic frontier model,comprehensive analysis and evaluation are conducted for the research performance of various departments.Results The overall average technical efficiency of the hospital is 0.44,and improvement space for the technical efficiency of scientific research performance is still 0.56.There are significant differences in the technical efficiency of each department.Among the four major categories,the D section is higher than the technical efficiency of class A,B and C departments.Conclusions The overall technical efficiency of the hospital is not high,the level of scientific research output of the four types of departments is not balanced,which should be emphasized in the improvement of scientific research performance level.

Objective Discussion on the methods of retrospectively selecting peer review experts based on the results of review.Methods Based on the review data of peer reviewers,peer review experts are retrospectively selected based on the voting,rating and comprehensive evaluations,as well as their variations and errors during the review.Results Through the retrospective selection of peer reviewers,there is a better convergence of reviews,which assures the quality of future peer reviews.This method is superior to the prospective selection of peer reviewers.Conclusions Based on the results of the review,retrospective selection of peer review experts is feasible and helpful for the selection of high-level peer review experts,which can improve the quality of peer review and standardize peer review.

Objective To study the dynamic changes of scientific research efficiency of 51 departments in a top three hospitals in Beijing from 2014 to 2016,and to provide reference information for improving the efficiency of scientific research in hospital departments.Methods The CCC model of DEA,BCC model were used for lateral analysis,and then Malmquist index was used for longitudinal analysis.Results There were 12 (23.53％) departments in 2014,11 (21.57％) departments in 2015,9 (17.65％) departments in 2016 data envelopment analysis was valid,from 2014 to 2016,41 (80.39％) departments of the hospital increased the total factor productivity.Conclusions The total factor productivity of the 51 departments in the hospital increased from 2014 to 2016,and technological progress was the main reason for its growth.