The high incidence and mortality of acute kidney injury (AKI) have brought great challenges to global health. In recent years, China has made some achievements in the epidemiology, risk factors and treatment of AKI. However, further prevention and treatment are still facing difficulties. Based on current new ideas and research progress, this paper summarized and analyzed the management throughout the whole course of AKI, including AKI risk assessment, early prevention, early identification, treatment and follow-up. The aim is to make Chinese nephrologists realize the focus of AKI prevention and treatment, standardize the management of AKI, and explore the prevention and treatment strategy suitable for AKI in China.
ObjectiveTo explore the predictive value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) for postoperative early outcomes in infants with aortic coarctation (CoA).MethodsA retrospective study was conducted in 344 children with CoA admitted to our hospital from September 2014 to October 2017, including 206 males (59.9%) and 138 females (40.1%), with an average age of 0.2-60.0 (7.1±10.6) months. The levels of NT-proBNP, clinical characteristics, imaging data and early follow-up results were collected and analyzed.ResultsCompared with the normal NT-proBNP group, there were statistical differences in age, the proportion of RACHS-1≥3, the proportion of preoperative pneumonia and dysplastic aortic arch, preoperative cardiac function, left ventricular wall thickness, left ventricular dilatation, hospital stay, ICU duration, ventilator duration, duration of vasoactive drugs use, delayed chest closure, nasal continuous positive airway pressure (nCPAP), postoperative cardiac insufficiency in the abnormal NT-proBNP group (P<0.05). According to multivariate logistic regression analysis, NT-proBNP level (>3 000 pg/mL) was an independent risk factor for prolonged ICU duration [OR=3.17, 95%CI (1.61, 6.23)], prolonged ventilator duration [OR=5.84, 95%CI (2.86, 11.95)], prolonged use of vasoactive drugs [OR=2.22, 95%CI (1.22, 4.02)], postoperative cardiac insufficiency [OR=3.10, 95%CI (1.64, 5.85)]; NT-proBNP level (> 5 000 pg/mL) was an independent risk factor for delayed chest closure [OR=3.55, 95%CI (1.48, 8.50)].ConclusionNT-proBNP level in children with CoA can be affected by many factors, including age, complexity of congenital heart disease, preoperative cardiac insufficiency, et al. The level of NT-proBNP has predictive value for postoperative early outcomes.
Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury (AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission (20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs. (11.13±3.41) d], rate of renal replacement therapy (35.0% vs. 0.0%), and 28-day mortality rate (25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group (P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group (P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98 (0.96, 1.00), 0.92 (0.83, 1.00), and 0.87 (0.78, 0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.
Non-invasive biomarkers, due to their non-invasive and safe characteristics, hold significant potential for the diagnosis and prognosis of epilepsy. This review summarizes the research progress and future directions of non-invasive biomarkers for epilepsy, encompassing electrophysiological, imaging, biochemical, and genetic markers, and discusses biomarkers for specific types of epilepsy, such as structural lesion-related epilepsy, infection and inflammation-related epilepsy, autoimmune epilepsy, endocrine hormone-related epilepsy, and metabolic epilepsy, to facilitate their clinical application.
ObjectiveTo investigate the expression level of exosome microRNA-21 (miRNA-21) in the bile and its clinical diagnostic value for the patients with cholangiocarcinoma. MethodsIn this study, 45 cases of cholangiocarcinoma admitted to Dongfeng General Hospital from August 2019 to December 2021 and met the inclusion criteria were selected and 35 patients with benign diseases of bile duct (choledocholithiasis or benign stricture of bile duct) during the same period were selected as control. The exosome in the bile was extracted by hypervelocity centrifugation method and identified. The exosome miRNA was extracted from the bile using a kit, then the expression level of miRNA-21 was detected by real-time fluorescent quantitative PCR. The diagnostic value of exosome miRNA-21 in the bile for cholangiocarcinoma was analyzed by receiver operating characteristic curve (ROC). ResultsThe isolated exosome in the bile conformed to the characteristics of recognized exosome and the concentration was higher. The average expression level of exosome miRNA-21 in the bile of the patients with cholangiocarcinoma was statistically higher than that in the patients with benign diseases of bile duct (59.45 verses 25.41, t=3.445, P<0.001). The area under the ROC curve was 0.715 [95%CI (0.602, 0.827), P=0.001]. The sensitivity and specificity of miRNA-21 in the diagnosis of cholangiocarcinoma were 75.6% and 62.9%, respectively. ConclusionFrom the results of this study, exosome miRNA-21 expression in bile is higher and it may be a potential early diagnostic marker for patients with cholangiocarcinoma.
Objective To summarize the research progress of microRNA in acute pancreatitis. Methods By reading the domestic and international literatures published in recent years, to summarize the research progress of microRNA in acute pancreatitis. Results In recent years, researches had found that microRNA could be used as a biomarker for acute pancreatitis to predict and determine the occurrence, development, and complications of acute pancreatitis. MicroRNA could regulate the programmed cell death of acute pancreatitis, and played an important role in the development of inflammation and complications, it also could be used as a therapeutic target for acute pancreatitis. Conclusions MicroRNA plays an important role in the development of acute pancreatitis. Researching the mechanism of microRNA in acute pancreatitis is helpful for the treatment and prevention of acute pancreatitis.
ObjectiveTo summarize the mechanism of action of programmed cell death protein 1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors, the application in breast cancer in recent years and the advances in the study of their bio-markers of effects. MethodRelevant literatures on PD-1/PD-L1 inhibitors and the study in the field of breast cancer were reviewed and summarized.ResultsIn recent years, the monotherapy of immune checkpoint inhibitors represented by PD-1/PD-L1 inhibitors or in combination with other therapies had brought new hope for patients with breast cancer especially triple-negative breast cancer (TNBC). However, only a small number of patients could benefit from breast cancer immunotherapy. The current researchers think that the efficacy of these drugs is related to PD-L1 expression in tumor tissue, tumor mutation burden (TMB), high level of microsatellite instability (MSI-H) and deficient mismatch repair (dMMR).ConclusionBreast cancer can benefit from the immunotherapy of PD-1/PD-L1 inhibitors, but formulating personalized medicine model, finding biomarkers that can predict efficacy and selecting patients with breast cancer who can benefit from it for targeted therapy are the new requirements in the new era of breast cancer immunotherapy.
ObjectiveTo summarize the role of circular RNA (circRNAs) in thyroid papillary carcinoma (PTC) and the emphasis of future research.MethodRelevant literatures in recent years about the biological function of circRNA and its role in PTC were reviewed.ResultscircRNAs had abnormal expression in PTC tissues. Besides, by working as miRNA sponges or interacting with RNA-binding proteins, circRNAs regulated the expression of proteins that were associated with cell proliferation, apoptosis, invasion, and metastasis, which could affect the biological characteristics of tumor cells.ConclusioncircRNAs are expected to be the biomarkers for early diagnosis of PTC or potential targets for PTC therapy and provid therapeutic bases to prevent PTC.
ObjectiveTo explore the clinical value of immunotherapeutic drugs represented by programmed cell death-1 (PD-1) / programmed cell death ligand-1 (PD-L1) blockades for treatment of advanced gastric cancer. MethodThe latest literatures about the clinical studies of PD-1/PD-L1 blockades for the treatment of advanced gastric cancer were retrieved and reviewed. ResultsThe corresponding clinical trials relevant to PD-1/PD-L1 blockades had been conducted in the treatment, biomarkers, and resistance to drugs for advanced gastric cancer. The PD-1/PD-L1 blockades single drug or its in combination with chemical drugs or (and) targeted drugs for the treatment of advanced gastric cancer or gastroesophageal junction cancer had shown a good efficacy in some patients. The patients who benefited from PD-1/PD-L1 blockades might be a population with specific molecular characteristics, but the resistance to drugs during the therapy process affected its therapeutic effect. ConclusionFrom the progress of this review, PD-1/PD-L1 blockades bring benefits to some patients with advanced gastric cancer, but more biomarkers which can predict the therapeutic effect need to be found to optimize the drug regimen, and the resistance to drugs mechanism needs to be further studied.
Objective To have more insight into roles of growth differentiation factor-15 (GDF15) in digestive tumor. Method The basic and clinical studies on the GDF15 in the digestive tumors published were searched in the databases for summarizing the latest advances on this issue. Results The GDF15, a novel member of transforming growth factor-β superfamily, played the diverse roles in the progress of the various diseases. The increasing number of evidence indicated that the GDF15 was associated with the diagnosis and prognostication of the digestive tumors, eg: colorectal cancer, hepatocellular carcinoma, pancreatic adenocarcinoma, and might serve as a potential biomarker and therapeutic target for the multiple digestive tumors. Conclusions Current basic and clinical studies provide some evidences that GDF15 plays a role in digestive tumors. Further studies are needed to elucidate its roles and molecular mechanisms in different stages of diseases.