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, Volume 48 Issue 2 Previous Issue    Next Issue
Stratified treatment and management of adenomyosis
ZHANG Xinmei,XU Ping
J Zhejiang Univ (Med Sci), 2019, 48(2): 123-129.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.01
Abstract( 220 )   HTML( 36 )     PDF(1005KB)( 97 )

In recent years, surgical and non-surgical excision and drug therapy have replaced hysterectomy as the main therapeutic modalities for adenomyosis. It is suggested that the precise clinical diagnosis should be based on the reconstruction of digitized three-dimensional model with original image data of adenomyosis. Patients' age and clinical manifestations should also be considered, and the patients should be stratified according to reproductive requirements, so as to determine the best treatment. In view of the infiltration and diffuse growth of adenomyosis lesions in the myometrium of the uterus, it is suggested that long-term drug management should be adopted after surgical or non-surgical lesion resection.Gonadotropin releasing hormone agonists, levonorgestrel-releasing intrauterine system, dienogest and short-acting oral contraceptives should be recommended to consolidate the curative effect in order to delay the progress of the disease and prevent recurrence.

Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis
ZHANG Lifeng,YANG Hui,ZHANG Xinmei,CHEN Zhengyun
J Zhejiang Univ (Med Sci), 2019, 48(2): 130-135.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.02
Abstract( 171 )   HTML( 18 )     PDF(914KB)( 48 )

Objective: To evaluate the efficacy and adverse effects of levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods: The clinical data of 75 patients with adenomyosis who had Mirena insertion in Women's Hospital, Zhejiang University School of Medicine from September 2013 to December 2013 were retrospectively analyzed. The patients were followed up to 39 months. The efficacy and adverse effects were assessed. Results: Pictorial Blood Loss Assessment Chart (PBAC) scores were decreased significantly after Mirena insertion both in patients with menorrhea (118±13 vs. 29±33, P < 0.01) and normal menstruation (82±15 vs. 14±13, P < 0.01); the patients with menorrhea showed a more significant decrease in PBAC score than those with normal menstruation (90±35 vs. 69±19, P < 0.01). The visual analogue scale (VAS) score decreased significantly after Mirena insertion compared with pre-treatment[7(6, 7) vs. 1(0, 2), P < 0.01]. The expulsion of Mirena occurred in 18 cases (24.0%); 9 cases (12.0%) had no effect and 28 cases (37.3%) had changes of menstruation patterns. Multivariate Cox regression analysis showed that the expulsion of Mirena was not associated with post-treatment VAS score, PBAC score before and after treatment or menstrual stabilization time (all P>0.05). Conclusion: Mirena is effective and safe in the long term management of adenomyosis, but about one third patients may require further treatment because of the expulsion or ineffectiveness of Mirena.

The second generation endometrial ablation (NovaSure) improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis
LOU Junyao,HUANG Xiufeng,ZHANG Lifeng,XU Ping,ZHANG Xinmei,CHEN Zhengyun
J Zhejiang Univ (Med Sci), 2019, 48(2): 136-141.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.03
Abstract( 141 )   HTML( 6 )     PDF(913KB)( 39 )

Objective: To determine the efficacy of second generation endometrial ablation (NovaSure) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods: Clinical data of patients with adenomyosis admitted in Women's Hospital, Zhejiang University School of Medicine from January 2015 to December 2018 were retrospectively analyzed. Among 66 patients, 44 received Mirena placement only (control group) and 22 received Mirena placement and NovaSure treatment (study group). The menstruation blood loss, dysmenorrhea score, uterine size, expulsion rate of Mirena and the patients' satisfaction rate were assessed in two groups. Results: There was a significant reduction in menstruation blood loss (P < 0.05) and significant improvement in dysmenorrhea (P < 0.05) after the treatment in both groups. The patients in study group had more marked improvement in menstruation blood loss than those in control group (P < 0.05). The patients' satisfaction was higher and the expulsion rate of Mirena was lower in study group than that in control group (all P < 0.05). The score of dysmenorrhea and the size of uterine had no significant difference between two groups (all P>0.05). Conclusion: NovaSure can improve the efficacy of Mirena in treatment of adenomyosis.

Progress on medical treatment in the management of adenomyosis
Baboo Kalianee Devi,CHEN Zhengyun,ZHANG Xinmei
J Zhejiang Univ (Med Sci), 2019, 48(2): 142-147.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.04
Abstract( 147 )   HTML( 9 )     PDF(908KB)( 31 )

Drug therapy plays an important role in alleviating the symptoms related to adenomyosis, improving the curative effect of surgery, delaying the progress of disease and promoting assisted reproduction. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first choice to control pain associated with adenomyosis, and are the only choice for patients with recent fertility requirements; steroid hormones, gonadotropin releasing hormone agonists and mifepristone can effectively relieve pain and control uterine bleeding, among which oral contraceptives, levonorgestrel-releasing intranterine system (Mirena) and dienogest are more effective and commonly used in clinic. Drug selection should be based on patient's age, symptoms, uterine size, fertility requirements and economical conditions. At present, there is no specific drug for adenomyosis, and symptoms are easy to recur after drug withdrawal, so the long-term drug use needs further study.

Identification of differentially expressed genes in peripheral blood mononuclear cells of patients with hepatocellular carcinoma and its regulatory network analysis
LUN Yongzhi,SUN Jie
J Zhejiang Univ (Med Sci), 2019, 48(2): 148-157.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.05
Abstract( 135 )   HTML( 13 )     PDF(1276KB)( 60 )

Objective: To identify the differentially expressed genes (DEGs) in peripheral blood mononuclear cells (PBMC) of patients with hepatocellular carcinoma (HCC) and to analyze their regulatory network. Methods: The DEGs in PBMCs of HCC patients were screened based on GEO database. The functional enrichment analysis and interaction analysis were carried out for DEGs. MCODE algorithm was used to screen core genes of DEGs, and the mirDIP and starBase online tools were used to predict upstream miRNAs and lncRNAs of the core genes. Results: A total of 265 DEGs with a high credibility were identified, which were mainly enriched in the biological activity, such as regulation of cell proliferation, metabolic regulation, cell communication and signaling, and inflammatory diseases according to Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and the two analyses were correlated. Four diagnostic candidate genes were identified, including FUS RNA binding protein, C-X-C motif chemokine ligand 8, cullin 1 and RNA polymerase Ⅱ subunit H. Subsequently, 10 miRNAs, 1 lncRNAs and 38 circRNAs were predicted, and finally a lncRNA/circRNA-miRNA-mRNA-pathway regulatory networks was constructed. Conclusion: The diagnostic candidate genes and its regulatory network in HCC PBMC have been identified based on data mining, which could provide potential tumor biomarkers for early diagnosis and treatment of HCC.

Effect of low-frequency pulsed electromagnetic fields on activity of rat calvarial osteoblasts through IGF-1R/NO signaling pathway
SHAO Jiale,LI Zhizhong,ZHOU Jian,LI Kai,QIN Rong,CHEN Keming
J Zhejiang Univ (Med Sci), 2019, 48(2): 158-164.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.06
Abstract( 111 )   HTML( 5 )     PDF(1008KB)( 28 )

Objective: To investigate the effect of low-frequency pulsed electromagnetic fields (PEMF) on the maturation and mineralization of rat cranial osteoblasts in vitro and its relation to IGF-1R/NO signaling pathway. Methods: The rat osteoblasts were isolated and cultured in vitro and randomly divided into blank control group, PEMF group, GSK group (IGF-1R blocker) and PEMF+GSK group. The cells were treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. After 3 d of PEMF treatment, the expressions of protein kinase (AKT), inducible nitric oxide synthase (iNOS) and cGMP-dependent protein kinase (PKG) were detected by Western blotting; on 6 d of PEMF treatment alkaline phosphatase (ALP) activity was determined; on 12 d of PEMF treatment the calcification nodule formation was demonstrated by Alizarin red staining. Results: NO level was significantly increased in rat osteoblasts treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. Western blot analysis showed that the expressions of AKT, iNOS and PKG protein in PEMF group were higher than those in the control group (all P < 0.01); the ALP activity was increased(P < 0.05), and the PEMF group had the largest area of Alizarin red staining (P < 0.01). The expressions of AKT, iNOS and PKG protein in GSK group were lower than those in the control group; the ALP activity was decreased (P < 0.05), and the GSK group had the least area of Alizarin red staining (P < 0.01). The expressions of AKT, iNOS, PKG protein, the ALP activity and the area of Alizarin red staining in PEMF+GSK group were between PEMF group and GSK group. Conclusion: PEMF may enhance the maturation and mineralization of rat cranial osteoblasts in vitro through IGF-1R/NO signaling pathway.

Controlled ovarian stimulation protocols in endometriosis patients: with antagonist or agonist?
YU Ya,WEI Kai,YAO Qiuping,TIAN Shen,LIANG Kun,ZHOU Liming,WANG Liping,JIN Min
J Zhejiang Univ (Med Sci), 2019, 48(2): 165-173.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.07
Abstract( 117 )   HTML( 4 )     PDF(945KB)( 35 )

Objective: To compare laboratory and clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in patients with endometriosis using antagonist protocol, long agonist protocol or prolonged agonist protocol. Methods: Totally 313 patients with endometriosis were recruited in Reproductive Centers of the Second Affiliated Hospital of Zhejiang University School of Medicine, Jiaxing Women and Children's Hospital, and Ningbo Women and Children's Hospital from April 2017 to October 2018, including 81 patients treated with antagonist protocol (antagonist group), 148 treated with long agonist protocol (long agonist group) and 84 treated with prolonged agonist protocol (prolonged agonist group). The clinical and laboratory data of the patients were retrospectively analyzed to investigate the effect of ovarian stimulation protocols on the IVF-ET outcomes of patients with endometriosis. Results: The average age in the antagonist group patients was significantly higher than those in the other two groups (all P < 0.05), and anti-mullerian hormone (AMH) level and antral follicle numbers were significantly lower than those in the other two groups (all P < 0.01). The numbers of average retrieved oocyte, fertilized oocyte and available embryo in the antagonist group were significantly lower than those in the long agonist group (all P < 0.05), but were similar with those in the prolonged agonist group (all P>0.05). Fertilization rate and available embryo rate were comparable among the three groups (all P>0.05). Considering analysis per cycle with embryo transfer, the human chorionic gonadotrophin (HCG) positive rate, clinical pregnancy rate and total implantation rate showed no significant difference among the three groups (all P>0.05). The implantation rate after fresh embryo transfer in the antagonist group was lower than that in the long agonist group (P < 0.05), but was similar with that in the prolonged agonist group (P>0.05). While the implantation rate of freeze-thaw embryo transfer showed a higher trend in the antagonist group, but there was no significant difference (P>0.05). The patients were further divided into diminished and normal ovarian reserve subgroups, the per cycle with embryo transfer, the HCG positive rate, clinical pregnancy rate and total implantation rate still showed no significant difference between two subgroups (all P>0.05), no matter in which ovarian stimulation protocol groups. Besides, in women with diminished ovarian reserve, the available embryo rate in antagonist group was significantly higher than that in the long agonist group (P < 0.05). The amount and duration of Gn application in antagonist group were significantly lower than those in long and prolonged agonist groups (all P < 0.05). Conclusion: Patients with endometriosis who used the antagonist protocol in IVF procedure could reduce the cost and time of Gn treatment, when combined with frozen-embryo transfer strategy the antagonist protocol has comparable clinical pregnancy outcome with long or prolonged agonist protocol, especially in those with diminished ovarian reserve, the higher available embryo rate can be achieved.

Body weight and gestational outcomes in women with high normotension during pregnancy
SUN Ting,XU Mingjuan
J Zhejiang Univ (Med Sci), 2019, 48(2): 174-179.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.08
Abstract( 135 )   HTML( 7 )     PDF(914KB)( 30 )

Objective: To investigate the pre-pregnancy body mass index(BMI), gestational weight gain(GWG)and gestational outcomes in women with high normotension during pregnancy. Methods: The clinical data of 1500 pregnant women who recieved antenatal care and delivered in Songjiang District Maternal and Child Hospital, Shanghai from 2015 to 2017 were retrospectively analyzed. The women were divided into high normotension group, normotension group and hypertensive disorder of pregnancy (HDP) group with 500 cases in each group. The general information, pre-pregnancy body mass index, gestational weight gain and gestational outcomes were analyzed. Results: There were significant differences in pre-pregnancy BMI and GWG between the high normotension group and the normotension group (all P < 0.017), and there was significant difference in pre-pregnancy BMI between the high normotension group and HDP group (P < 0.017). In terms of adverse pregnancy outcomes, the incidence of oligohydramnios, placental abruption, postpartum hemorrhage, fetal distress and small for gestational age infant were higher in the high normotension group than those in the normotension group, but the differences were not of statistical significance (all P>0.017); the incidence of oligohydramnios, placental abruption, cesarean section, postpartum hemorrhage, premature delivery and small for gestational age infant in HDP group were higher than those in high normotension group (all P < 0.01). In high normotension women with adverse gestational outcomes, the proportion of low GWG or too much GWG was higher and the proportion of normal GWG was lower than those in high normotension women without adverse gestational outcomes (all P < 0.01). Conclusions: Pre-pregnancy BMI and GWG are correlated with pregnancy blood pressure and gestational outcomes. Reasonable intervention to gestational weight gain of pregnant women with high normotension is of significance to improve the gestational outcomes.

Associations of mean arterial pressure levels with mortality in patients with peritoneal dialysis
LYU Duo,XIE Xishao,ZHANG Xiaohui,CHEN Jianghua
J Zhejiang Univ (Med Sci), 2019, 48(2): 180-185.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.09
Abstract( 109 )   HTML( 4 )     PDF(938KB)( 37 )

Objective: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). Methods: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. Results: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95- < 120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (HR=1.40, 95%CI:1.01-1.93, P < 0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (HR=2.12, 95%CI:1.32-3.40, P < 0.01) and cardiovascular morality (HR=2.55, 95%CI:1.38-4.70, P < 0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. Conclusion: Both high MAP and low MAP are associated with higher risk of mortality in PD patients.

Digital breast tomosynthesis in diagnosis of dense breast lesions
XU A'qiao,HE Hongqin,SHI Qiujun,LI Zhiqing,ZHANG Shengjian
J Zhejiang Univ (Med Sci), 2019, 48(2): 186-192.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.10
Abstract( 96 )   HTML( 4 )     PDF(971KB)( 15 )

Objective: To evaluate the value of digital breast tomosynthesis (DBT) in diagnosis of dense breast lesions. Methods: Clinical and pathological data of 163 patients (58 benign lesions, 122 malignant lesions, and 180 lesions in total) with breast lesions undergoing surgical treatment in Shaoxing Central Hospital from January 2017 to December 2018 were retrospectively analyzed. The lesions were classified into non-homogeneous dense gland type and extremely dense gland type according to BI-RADS creterion. Breast MRI and DBT examinations were performed before the surgery. ROC curve was generated and the diagnostic efficacy of two examination methods for dense breast lesions was evaluated with pathological results as the gold standard. The detection rate, diagnostic accuracy of benign and malignant breast lesions were compared between two methods using chi-square test. The accuracy of lesion size preoperatively evaluated by MRI and DBT was analyzed by Pearson correlation. Results: The detection rate and diagnostic accuracy for benign breast lesions by MRI were higher than those by DBT (91.4% vs. 75.9%, χ2=5.098, P < 0.05 and 89.7% vs. 67.2%, χ2=8.617, P < 0.01). But there were no significant differences in detection rate and accuracy for malignant lesions by MRI and DBT (98.4% vs. 95.1%, χ2=2.068, P>0.05 and 94.3% vs. 91.8%, χ2=0.569, P>0.05). The areas under the ROC curves of MRI, DBT based on BI-RADS classification were 0.910 and 0.832, respectively (Z=1.860, P>0.05). The sensitivities of MRI, DBT to breast lesions were 93.3% and 86.7%, and the specificities were 68.3% and 79.1%. DBT and MRI measurements were positively correlated with pathological measurements (r=0.887 and 0.949, all P < 0.01). Conclusion: DBT can effectively diagnose benign and malignant breast lesions under dense gland background, and it has similar diagnostic efficacy with MRI for breast malignant lesions.

PET/CT imaging manifestations of different pathological subtypes of liposarcoma
FU Jianlan,SONG Fahuan,CHENG Aiping
J Zhejiang Univ (Med Sci), 2019, 48(2): 193-199.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.11
Abstract( 132 )   HTML( 14 )     PDF(1034KB)( 16 )

Objective: To analyze PET/CT imaging manifestations of different pathological subtypes of liposarcoma. Methods: The 18F-fluorodeoxyglucose(FDG) PET/CT features of 13 patients pathologically confirmed as liposarcoma were retrospectively reviewed. The metabolism degree and distribution of different subtypes of liposarcoma were compared. Results: The well-differentiated liposarcoma showed fat density mass with septa and irregular strip with mild FDG uptake. The myxoid liposarcoma showed cystic or cystic solid mass, single or multiple with mild-moderate FDG uptake heterogeneously or homogeneously. The dedifferentiated liposarcoma showed mixed soft tissue mass with high FDG uptake heterogeneously, larger lesion with necrosis centrally. The mixed type contained well differentiated type and dedifferentiated type, and showed multiple lesion with combined imaging manifestations. There were local invasions in 12 cases, no lymph node matastasis, and the recurrence of dedifferentiated liposarcoma with lung metastasis in 1 case. The maximum standard values (SUVmax) of FNCCLE grade G1, G2 and G3 liposarcoma were 3.00, 5.67 and 10.33, respectively; there was significant difference between G1 and G3 groups, G2 and G3 groups (all P < 0.05). Conclusions: PET/CT manifestations of liposarcoma of various pathological subtypes are different. Preoperative PET/CT examination can clarify the pathological types, scope of tumor invasion and metastasis of liposarcoma, which provides more information for clinical decision-making and is helpful for the preparation of surgical plan.

A novel mutation W257R in GCK gene discovered from a Chinese patient with maturity onset diabetes of the young
HONG Pingping,GUO Bingjie,LIN Li,LIN Xihua,ZHOU Jiaqiang
J Zhejiang Univ (Med Sci), 2019, 48(2): 200-203.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.12
Abstract( 124 )   HTML( 7 )     PDF(960KB)( 28 )

Maturity onset diabetes of the young (MODY) is a monogenic autosomal dominant inherited disease. Its clinical manifestations are asymptomatic with slightly elevated fasting blood glucose and few complications. This paper reports a novel mutation W257R in glucokinase (GCK) gene from a Chinese patient with MODY. Heterozygous mutation c.769T>C (p.W257R) in exon 7 of GCK gene (Chr744187343) was found in the proband, her father and brother. This W257R mutation was first reported in Chinese population.

Roles of macrophages in formation and progression of intracranial aneurysms
WANG Yaqi,JIN Jinghua
J Zhejiang Univ (Med Sci), 2019, 48(2): 204-213.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.13
Abstract( 214 )   HTML( 16 )     PDF(995KB)( 78 )

Studies have shown that chronic inflammatory response plays a key role in intracranial aneurysms (IA) formation and progression, and macrophages regulate the formation and progression of IA through a variety of pathways. Bone marrow monocyte-derived macrophages and resident-tissue macrophages infiltrate the vessel wall, after infiltration macrophages are polarized into various polarization phenotypes dominated by M1-like and M2-like cells. Polarized phenotypes of macrophages can regulate the formation and progression of intracranial aneurysms by releasing cytokines and regulating the inflammatory response of other immune cells, as well as release different cytokines to regulate the process of extracellular matrix remodeling. Some important progresses have been made in the clinical detection and treatment in targeting macrophages. This review provides a summary on the pathogenesis of IA and potential drug targets to prevent the formation and rupture of intracranial aneurysms.

Research progress on miR-21 in heart diseases
YANG Kun,HU Xiaosheng
J Zhejiang Univ (Med Sci), 2019, 48(2): 214-218.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.14
Abstract( 168 )   HTML( 10 )     PDF(884KB)( 76 )

Pathological processes such as myocardial apoptosis, cardiac hypertrophy, myocardial fibrosis, and cardiac electrical remodeling are involved in the development and progression of most cardiac diseases. MicroRNA-21 (miR-21) has been found to play an important role in heart diseases as a novel type of endogenous regulators, which can inhibit cardiomyocyte apoptosis, improve hypertension and cardiac hypertrophy, promote myocardial fibrosis and atrial electrical remodeling. In this review, we summarize the research progress on the function of miR-21 in heart diseases and its mechanism, and discuss its potential application in diagnosis and treatment of heart diseases.

Effects of aerobic glycolysis on pathogenesis and drug resistance of non-Hodgkin lymphoma
XU Li,XU Ming,TONG Xiangmin
J Zhejiang Univ (Med Sci), 2019, 48(2): 219-223.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.15
Abstract( 176 )   HTML( 7 )     PDF(884KB)( 42 )

It has been shown that aerobic glycolysis (AG) plays an important role in the pathogenesis and resistance mechanism of non-Hodgkin lymphoma (NHL) in recent years. Signaling pathway related to abnormal activation of AG can increase the level of AG in lymphatic and hematopoietic cells, while the enzymes related to the activity of AG are involved in the pathogenesis and prognosis of NHL. Drugs that inhibit AG can also inhibit NHL cells in vitro. Drugs inhibiting AG may increase the sensitivity of chemotherapeutic agents and prevent drug resistance. In this article, the role of signaling pathway proteins and regulatory genes related to AG in the pathogenesis and drug resistance of NHL are reviewed, and the AG as a target in the clinical diagnosis and treatment of NHL is discussed.

Biomarkers of cardiac surgery-associated acute kidney injury: a narrative review
WU Binbin,YANG Yi
J Zhejiang Univ (Med Sci), 2019, 48(2): 224-229.   https://doi.org/10.3785/j.issn.1008-9292.2019.04.16
Abstract( 123 )   HTML( 16 )     PDF(892KB)( 38 )

Cardiac surgery-related acute kidney injury (CSA-AKI) is a common and serious complication after cardiac surgery in adults. Currently, there is no specific examination method, and the diagnosis relying on serum creatinine and urine volume changes is of hysteresis. Biomarkers with the potential to predict CSA-AKI have become the focus in recent years. Clinical studies have shown that neutrophil gelatinase related lipid transporters and cell cycle inhibitors are of high diagnostic value; liver fatty acid binding protein can be used to assist in the diagnosis of CSA-AKI; microRNAs help to assess the poor prognosis of patients; the combined application of biomarkers may be used to predict the occurrence of CSA-AKI. CSA-AKI biomarkers provide the possibility for early clinical diagnosis and timely intervention, and are expected to become a new breakthrough in the diagnosis and treatment of CSA-AKI.

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