OBJECTIVE: To identify and validate novel biomarkers for the early diagnosis of sepsis-associated acute kidney injury (SA-AKI) and precise continuous renal replacement therapy (CRRT) using proteomics. METHODS: A prospective multicenter cohort study was conducted. Patients with sepsis admitted to five hospitals in Taizhou City of Zhejiang Province from April 2019 to December 2021 were continuously enrolled, based on the occurrence of acute kidney injury (AKI). Sepsis patients were divided into SA-AKI group and non-SA-AKI group, and healthy individuals who underwent physical examinations during the same period were used as control (NC group). Peripheral blood samples from participants were collected for protein mass spectrometry analysis. Differentially expressed proteins were identified, and functional enrichment analysis was conducted on these proteins. The levels of target proteins were detected by enzyme linked immunosorbent assay (ELISA), and the predictive value of target protein for SA-AKI were evaluated by receiver operator characteristic curve (ROC curve). Additionally, sepsis patients and healthy individuals were selected from one hospital to externally verify the expression level of the target protein and its predictive value for SA-AKI, as well as the accuracy of CRRT treatment. RESULTS: A total of 37 patients with sepsis (including 19 with AKI and 18 without AKI) and 31 healthy individuals were enrolled for proteomic analysis. Seven proteins were identified with significantly differential expression between the SA-AKI group and non-SA-AKI group: namely cystatin C (CST3), β ₂-microglobulin (β ₂M), insulin-like growth factor-binding protein 4 (IGFBP4), complement factor I (CFI), complement factor D (CFD), CD59, and glycoprotein prostaglandin D2 synthase (PTGDS). Functional enrichment analysis revealed that these proteins were involved in immune response, complement activation, coagulation cascade, and neutrophil degranulation. ELISA results demonstrated specific expression of each target protein in the SA-AKI group. Additionally, 65 patients with sepsis (38 with AKI and 27 without AKI) and 20 healthy individuals were selected for external validation of the 7 target proteins. ELISA results showed that there were statistically significant differences in the expression levels of CST3, β ₂M, IGFBP4, CFD, and CD59 between the SA-AKI group and non-SA-AKI group. ROC curve analysis indicated that the area under the curve (AUC) values of CST3, β ₂M, IGFBP4, CFD, and CD59 for predicting SA-AKI were 0.788, 0.723, 0.723, 0.795, and 0.836, respectively, all exceeding 0.7. Further analysis of patients who underwent CRRT or not revealed that IGFBP4 had a good predictive value, with an AUC of 0.84. CONCLUSIONS Based on proteomic analysis, CST3, β ₂M, IGFBP4, CFD, and CD59 may serve as potential biomarkers for the diagnosis of SA-AKI, among which IGFBP4 might be a potential biomarker for predicting the need for CRRT in SA-AKI patients. However, further clinical validation is required.
Humans ; Sepsis/complications* ; Acute Kidney Injury/blood* ; Proteomics ; Prospective Studies ; Biomarkers/blood* ; Male ; Female ; beta 2-Microglobulin/blood* ; Middle Aged ; Cystatin C/blood* ; Aged

Objective:To explore the "Internet + nursing service" model based on the nurse-patient safety needs, and provide reference for development of "Internet + nursing service".Methods:The First Affiliated Hospital of Sun Yatsen University established a "Internet+ nursing service" management team in December 2019, developed an information platform, formulated and implemented a specific plan of the "Internet+ nursing service" model, including service objects, service projects and service modes. After the smooth operation of this model, the statistics of the nursing service projects and service times that had been carried out from September 2020 to March 2021, as well as the satisfaction of 21 patients who received nursing services would be counted.Results:From September 2020 to March 2021, 21 patients were provided with 55 on-site nursing services, and 151 operations in 16 projects were completed. No nursing-related adverse events occurred. The patients gave all five-star evaluations to the door-to-door service, the satisfaction score was 5 points, and the overall evaluation was 99.88 points.Conclusions:The pilot work of "Internet + nursing service" based on the nurse-patient safety needs has met the care needs of discharged patients and the safety needs of door-to-door services, guarantee the safety of nurses' door-to-door service effectively. And it provides reference for the development and improvement of "Internet + nursing service" related safety work in tertiary A-level hospitals.

Objective: To evaluate an innovative teaching mode on obstetrics and gynecology for clinical interns. Methods: A total of 195 students from Grade 2015 of Clinical Medicine (Group 2018) were enrolled to receive the innovative teaching mode. This mode was based on organ integration medicine,focused on solving problems and improving teacher-student interaction, and provided creative homework and more clinical practice for students. The teaching results were evaluated objective and structured clinical examinations and questionnaire, and by comparing their scores with those of the former two grades (Grade 2013 and 2014). The statistical analysis was performed with SPSS 21.0. Results: Scores of objective and structured clinical test in Group 2018 was higher than those in the two groups former of the same period, and the difference was statistically significant (P<0.05). Satisfaction in Group 2018 was higher than that in the former two groups (P<0.05). Conclusion The their innovative teaching mode can help students to integrate theories with practice and cultivate ability of clinical thinking.

For a long time, limited by the factors such as laparoscopic technology, and limited medical resources , the residents accepting standardized training are lack of mastery of the technology . Meanwhile, it is the key to the training of personnel training and reserve in the field for residents to contact the laparoscope as soon as possible and carry out scientific and effective training. Therefore, based on the traditional method, we have developed a new type of laparoscopic teaching system for the standardized training residents and increased and integrated the LAP GAME R operations training system and the real-time multimedia teaching platform. The preliminary practice effect is good.

Objective To analyze the effect of one-part form mini-implant in treatment of immediately and delayed repair of edentulous space. Methods Retrospectively analyzed 80 cases of edentulous space patients in our hospital from Jan. 2009 to Jan. 2011, and divided them into the immediately repair group ( observation group) and the delayed repair group ( control group) according to time of edentulous space repair. Patients of the two groups were given permanent PFM 3 months later, and regular clinical and X-ray examinations were made to evaluated clinical efficacy and complications of the two groups. Results The score of ISQ of the observation group was higher than that in the control group with significant difference (P <0. 05); and the postoperative complications of the observation group was significantly decreased compared to the control group with a significant difference (P <0. 05). Conclusion Mini-implant used in immediately repair in edentulous space can remove pain in a short time with less postoperative complications, it has more advantages than delayed repair of edentulous space.

Objective To design a kind of suitable equipment to collect the specimens from endoscopic mucosal resection (EMR),and observe the effect of the collector on clinical application. Methods The six-hole rotating collector was made from transparent glass,in which the specimens could be aspirated through the channel and remained in a mental net. A total of 813 cases with 1254 lesions in esophagus,stomach and large intestine were included in the study. All the cases were male 516,female 297,age in 7-90 years old (average 53.2 years). The collector was used for receiving these EMR specimens that less than 1cm in diameter. The final diagnoses were proved by histopathologic examination. Results The rotating collector was named as Transparent 6-hole Rotating Eodoscopic Specimen Collector,and registered as national patent. The collector was a round column type,about 160g in weight and 56 mm?60 mm in size,which was light,clear and easily cleaned,and worked well during clinical application. The total collecting success rate for specimen receiving is 93.3%. All the specimen samples kept undamaged and good for histological analysis. Conclusion The rotating specimen collector is useful and economic for endoscopic mucosal resection.

Objevtives: To explore the relationship between ? aminobutyric acid (GABA) and the proliferation or differentiation of jejunal epithelial cells. Methods: Immunohistochemical expression of GABA, glutamate decarboxylase (GAD, including two isoforms, GAD65 and GAD67) was investigated in rat jejunum. Meanwhile, double staining was performed with GAD65 immunohistochemistry followed by lectin histochemistry of fluorescent wheat germ agglutinin. Furthermore, cell kinetics was evaluated by immunohistochemistry using a monoclonal antibody to proliferating cell nuclear antigen (PCNA). Results: Immunoreactive GABA and GAD65 were distributed in the villi of jejunum, while GAD67 was negative in epithelial cells. Strong positive staining of GABA and GAD65 was mainly localized along the brush border of jejunal villi. In addition, there existed a few GABA and GAD65 strong positive cells scattering in upper portion of the jejunal villi. Double staining showed that immunoreactive GAD65 was not found in goblet cells. PCNA staining nucleoli were found in the lower and the middle portions of the jejunal crypts. Therefore, GABA and GAD65 were expressed in maturation or functional zone. Conclusion: It suggests that GABA might be involved in the regulation of differentiation and maturation of epithelial cells in rat jejunum.

Objective: To evaluate the contents of ? aminobutyric acid(GABA) and glutamate(Glu) in gastric cancer tissue and normal tissue surrounding the cancer. Methods: 30 patients of gastric cancer underwent surgical treatment were examined. A high performance liquid chromatographic method(HPLC) was applied for the analysis and quantification of GABA and Glu in gastric cancer tissues and normal tissues surrounding the lesion after precolumn derivatization with phenylisothyocyanate (PITC). GABA and Glu were determined with UV detector. The differences in GABA and Glu contents in gastric cancer tissues were regarded to have close link of lymph node metastasis and histological type. Results: GABA and Glu contents were high significantly in gastric cancer tissue comparing with those of surrounding normal tissue( P 0.05). Conclusion: GABA and Glu are involved in the factors of gastric carcinogenesis. The results suggest GABA Glu system detection should be included into the diagnosis and therapy consideration in gastric cancer.

Objective To explore the role of glutamate decarboxylase (GAD) in the pathogenesis of human gastric cancer. Methods Thirty patients with primary gastric cancers who were diagnosed and treated at our hospital were enrolled into the current study. Immunohistochemistry was carried out to check the ex-pression of GAD protein. Reverse transcription polymerase chain reaction ( RT-PCR) was performed to ex-amine the expression of GADmRNA. Then investigated the relationships among the sites of gastric cancer, depth of infiltration, and degree of differentiation, staging and lymphatic metastasis. Results Immunohisto-chemistry analysis showed that GAD expression decreased in gastric cancer tissues compared with that of ad-jacent normal tissue(P

objective The consequences of macroscopic classification for early colorectal cancer(CRC),carried out by clinicians from China and Japan,were compared.Methods The endoscopic color photos and related materials of 7 selected patients with early CRC were distributed to each of 5 endoscopists from China and Japan to present everyone's own idea on classification.Results Some lesions assumed as typeⅡ (flat pattern) by Japanese were considered as typeⅠ (elevated pattern)by Chinese.While the lesions having protrusion with central depression were depicted by physicians of both sides according to the ratio of areas with different outlook,namelyⅡ a＋Ⅱ c orⅡ c＋Ⅱ a.Some new terms have been adopted currently by Japanese only,such asⅡ a＋ depression,LST(laterally spreading tumor).Conclusion Regarding the macroscopic classification indices for early CRC discrepancies exist between Sino-Japanese doctors.More comments and cooperation seem necessary to set up an unified criterion.