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 summarize the research progress of long non-coding RNA (lncRNA) in the regulation of malignant biological behavior of gallbladder cancer so as to provide references for its related research.MethodThe relevant literatures about studies of lncRNA in gallbladder cancer in recent years were reviewed.ResultsThe recent studies had shown that 19 lncRNAs associated with gallbladder cancer had played the important roles in regulating tumor cell proliferation, migration, invasion, apoptosis, “sponge” miRNAs, chemoresistance, and tumor metastasis. Among them, most lncRNAs tended to have carcinogenic properties, only a few had anticarcinogenic effect. Although the research suggested the mechanism and role of lncRNA to promote or inhibit the occurrence and development of gallbladder cancer, the current research on its mechanism was still limited. In addition, some lncRNAs were found to be specifically expressed in the serum of patients with gallbladder cancer, so which were expected to become biomarkers for tumor diagnosis and prognosis.ConclusionslncRNAs associated with gallbladder cancer have carcinogenic or anticarcinogenic effect, or chemoresistance. They play potential roles in diagnosis, prognosis, and (or) treatment of tumors, but molecular mechanisms of their effects are still limited.
ObjectiveTo summarize the biomarkers related to the efficacy of immune checkpoint inhibitors for hepatocellular carcinoma (HCC).MethodReviewed and summarized the literatures on the basic and clinical application of biomarkers related to programmed cell death protein 1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors and their combination with targeted therapy.ResultsThe combination of immunotherapy and targeted therapy had brought great hope for the treatment of patients with advanced HCC, but there were still some patients who could not benefit from it. Recent studies had shown that expression of PD-L1 in tumor tissue, tumor mutational burden, tumor-infiltrating lymphocytes, peripheral immune cells, circulating tumor DNA, gut microbiome, and so on, could predict the efficacy of immunotherapy or targeted therapy combined with immunotherapy for HCC.ConclusionsThere is no specific biomarker to predict the efficacy of immunotherapy and its combination regimen for HCC. More prospective studies are needed to confirm the predictive value of these biomarkers and to establish a multi-factor predictive model or immune score to screen patients who may benefit, which is of great significance for precise immunotherapy of HCC.
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 investigate the impact and mechanisms of periostin (POSTN), Krebs von den Lungen-6 (KL-6), pulmonary surfactant protein A (SP-A), and pulmonary surfactant protein D (SP-D) on the diagnosis and disease assessment of idiopathic pulmonary fibrosis (IPF), and conduct a comparative analysis. Methods From October 2022 to October 2023, a total of 55 patients diagnosed with IPF and treated at the Third Affiliated Hospital of Anhui Medical University were enrolled as an IPF group. Additionally, 30 patients with bacterial pneumonia and 30 healthy individuals undergoing concurrent health examinations during the same period were selected as a pneumonia control group and a healthy control group, respectively. All participants underwent enzyme-linked immunosorbent assay to measure serum levels of POSTN, KL-6, SP-A, and SP-D, along with pulmonary function tests. The IPF patients also underwent high-resolution computed tomography (HRCT) and echocardiography to quantify HRCT scores and pulmonary artery systolic pressure (PASP). Receiver operating characteristic (ROC) curves were plotted to analyze the significance of serum POSTN, KL-6, SP-A, and SP-D levels in IPF diagnosis. Pearson and Spearman correlation tests were used to analyze the relationships between these biomarkers and pulmonary function, PASP, and HRCT scores. Results Serum concentrations of POSTN, KL-6, SP-A, and SP-D were significantly elevated in the IPF group compared with the pneumonia group and the healthy controls (P<0.05), while serum levels of SP-A and SP-D were notably higher in the pneumonia group compared with the healthy control group (P<0.05). Within the IPF group, serum POSTN levels were negatively correlated with forced expiratory volume in the first second as a percentage of predicted value (FEV1%pred) and diffusion capacity of the lung for carbon monoxide as a percentage of predicted value (DLCO%pred) (P<0.05); KL-6 and SP-D levels were also negatively correlated with FEV1%pred, forced vital capacity as a percentage of predicted value (FVC%pred), and DLCO%pred (P<0.05); and the concentration of SP-A was negatively correlated with DLCO%pred and positively correlated with PASP (P<0.05). Additionally, serum levels of POSTN, KL-6, and SP-A in the IPF group showed significant positive associations with HRCT scores (P<0.01). Conclusions POSTN is a valuable serum biomarker for IPF, exhibiting the highest sensitivity and specificity among the four serum markers, with diagnostic performance superior to KL-6, SP-A, and SP-D. POSTN, KL-6, SP-A, and SP-D can all be used for the diagnosis and assessment of IPF.
ObjectiveTo summarize the research progress in the study of the diagnostic function of humoral circular RNAs in human diseases.MethodsThe research progress was summarized by reading relevant literatures on the diagnostic function of humoral circular RNAs in human disease at home and abroad.ResultsAs endogenous circular RNA molecules, circular RNAs were found to be related to a variety of diseases due to their stable structures, conserved sequences, diverse functions, and tissue cell specificity. Recent studies had found that circular RNAs could be secreted into body fluids, such as blood, saliva, urine, gastric juice, seminal plasma, and so on. They could also exist in body fluids stably. In addition, circular RNAs were found that was related to the diagnosis of various diseases, including cardiovascular diseases, nervous system diseases, autoimmune diseases, various carcinomas and metabolic diseases, and so on. As a consequence, circular RNAs might be important biomarkers for non-invasive detection of human diseases.ConclusionsRecent researches have found that circular RNA is related to the diagnosis of various diseases. Therefore, the in-depth study of the relationship between humoral circular RNAs and the diagnosis of diseases is conducive to the development of non-invasive diagnostic markers of clinical diseases, which is of great significance for the non-invasive diagnosis of diseases.
ObjectiveTo understand the research status and future directions of circular RNA (circRNA) in pancreatic cancer, and to provide references for its further research.MethodThe recent literatures on studies of the role of circRNA in the pancreatic cancer were reviewed.ResultsThe retsults of high-throughput sequencing had shown that large amounts of circRNA expressed abnormally in the pancreatic cancer tissues and pancreatic cancer cell lines, and they participated in the occurrence and development of pancreatic cancer, drug resistance, autophagy, and immune escape by regulating downstream target molecules such as microRNA or RNA-binding protein.ConclusionCertain circRNAs with important function are expected to become biomarkers for early diagnosis of pancreatic cancer and molecular targets for treatment, so as to achieve goals of early diagnosis and targeted therapy of pancreatic cancer.
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.
ObjectiveTo detect the expression of Ki-67 in papillary thyroid carcinoma (PTC) and investigate its clinical significance. MethodsA retrospective analysis was conducted on PTC patients treated at West China Hospital of Sichuan University from August 2024 to February 2025. The relation between the Ki-67 expression in the postoperative pathological tissues and clinicopathologic features was analyzed. Additionally, the concordance of Ki-67 expression between the preoperative fine-needle aspiration samples and postoperative pathological tissues was evaluated by Bland-Altman analysis. The significance level was set at α=0.05. ResultsA total of 290 PTC patients met the inclusion and exclusion criteria were enrolled. Patients with classical PTC, M1 classification, TNM stage Ⅳ, and those achieving thyroid stimulating hormone (TSH) suppression targets at one month postoperatively had higher Ki-67 expression than those with follicular variant PTC, M0 classification, TNM stages Ⅰ–Ⅲ, or inadequate TSH suppression (all P＜0.05). No significant differences were observed in other subgroups (P>0.05). Furthermore, Bland-Altman analysis of 27 paired samples showed a mean bias of 1.269% between preoperative and postoperative measurements. Elevated variability occurred in high Ki-67 cases, with 11.1% (3/27) exceeding ±6% limits of agreement. ConclusionsThe study demonstrates that Ki-67 expression correlates with malignant attributes including tumor aggression and advanced disease. It may serve as a prognostic biomarker for assessing malignant potential in PTC.
Objective To understand the dynamic changes of inflammatory indicators in the peripheral blood of patients with malignant cerebral edema at different time points after acute cerebral infarction, and provide a basis for early prediction and prevention of malignant cerebral edema. Methods Consecutive patients with acute cerebral infarction within 24 h of onset who were admitted to the Department of Neurology, West China Hospital of Sichuan University between January 1st, 2017 to December 31st, 2018 were collected. The basic clinical data of the patients were collected, and the data of inflammatory cells (white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio) and acute phase reactants (blood glucose, fibrinogen, albumin, and fibrinogen to albumin ratio) were dynamically collected at admission and 1, 3, and 7 d after admission, respectively. Differences between groups were compared using generalized estimating equations. Results A total of 798 patients with acute cerebral infarction were included, of whom 93 (11.65%) developed malignant cerebral edema. At all time points examined, the white blood cell counts, absolute neutrophil counts, and neutrophil to lymphocyte ratios were higher in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=63.737, P<0.001; Wald χ2=91.848, P<0.001; Wald χ2=75.197, P<0.001); 1 and 3 d after admission, the absolute lymphocyte counts were lower in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=18.580, P<0.001). The blood glucose levels were higher in the malignant cerebral edema group compared with the non-malignant cerebral edema group 1, 3, and 7 d after admission (Wald χ2=16.722, P<0.001); no significant between-group effect was found in the albumin levels (Wald χ2=3.643, P=0.056); the fibrinogen levels were significantly different between groups 3 d after admission (Wald χ2=8.923, P=0.003), and the fibrinogen to albumin ratios differed between the two groups 3 and 7 d after admission (Wald χ2=6.739, P=0.009). Dynamic analysis of multiple time points in the malignant cerebral edema group found that these inflammatory markers mostly reached their extreme values 3 d after admission. Conclusions Compared with the non-malignant cerebral edema group, the inflammatory cell-related indicators (except lymphocytes) and the acute phase inflammatory reactant-related indicators in malignant cerebral edema patients are significantly higher, and the absolute lymphocyte count is significantly lower. Three days after admission to hospital is probably the most significant time point for the change of each inflammatory indicator.