[China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing)]

Esophageal cancer (EC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demonstrated that screening and early detection are effective in reducing the incidence and mortality of EC. The development of the guideline for EC screening and early detection in line with epidemic characteristics of EC in China will greatly promote the homogeneity and standardization, and improve the effect of EC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of EC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of EC screening and provide scientific evidence for the EC prevention and control in China.

[Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging]

OBJECTIVE

To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions.

METHODS

We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed.

RESULTS

There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ²=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively.

CONCLUSION

MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

[Access to liver cancer screening and surveillance in populations in China: an exploratory analysis]

Objective: To systematically quantify the access to screening and surveillance service of liver cancer in populations in China, especially a series of sub-indicators of the availability. Methods: Following the specific indicators applied by the International Agency for Research on Cancer in the session of availability and use of screening practices in several cancer screening handbooks, information about the access/availability of liver cancer screening and surveillance in population in China were collected; the indicators included local policies and guidelines, procedures most commonly used or recommended, population coverage and participation rate, compliance and related factors, treatment rate, acceptability, equity and others. Systematic review approach was used, combined with searching core literatures/monograph, websites of governments and available program reports, for a systematic analysis on the access to liver cancer screening and surveillance in populations in China. Results: A total of 34 journal articles were included from the systematic review and most of which were about the participation of secondary liver screening or surveillance compliance; additional information were mainly obtained from the other sources. Overall, there were clearly recommended screening and surveillance procedures for liver cancer in the three major cancer screening programs funded by the central government of China. It was estimated that 0.09% of the population aged 35-74 years were covered by liver cancer screening in 2019 in China. The overall participation rates of secondary screening ranged from 37.5% to 62.3% in three major programs, the median compliance rate of surveillance was reported as 26.9% (Q₁,Q₃: 23.5%, 41.0%) in the 6 included studies. Two studies reported the factors affecting the participation and compliance. A large-scale multicenter analysis showed that the subject acceptability to alpha fetoprotein test combined with ultrasound screening was as high as 99.3% in high-risk population in urban area. The treatment rate of liver cancer founded by screening, surveillance or follow-up was estimated to be >90% in rural population. No studies of equity were obtained via the systematic review. Conclusions: The public health service programs in China all recommend specific procedures for liver cancer screening in general population and surveillance for high-risk individuals. However, the overall availability needs to be improved, particularly in the indicator of population coverage. Participation rates of screening and compliance rates of surveillance varied among the included programs and the studies, suggesting that the influencing factors need to be further identified. The relatively high subject acceptability suggests the potential demands for screening service. More efforts are needed to address the access to screening and surveillance of liver cancer in populations in China.

[QUADAS-C-A tool for assessing risk of bias regarding Quality Assessment of Diagnostic Accuracy Studies-Comparative]

This paper introduced the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C), illustrated the comparison with the QUADAS-2, and using QUADAS-C together with QUADAS-2 to present QUADAS-C results through systematic reviews. Like the domain for QUADAS-2, QUADAS-C retained four domains, including patient selection, index test, reference standard, flow, and timing, and comprised additional questions for each QUADAS-2 part. Unlike the QUADAS-2 tool, the starting question of each domain for QUADAS-C was designed to summarize the risk of biased information captured by QUADAS-2. QUADAS-C only dealt with the risk of bias but did not include the part of concerns regarding applicability. The answers to signaling questions for each domain of QUADAS-C would lead to a 'low''high' or 'unclear' risk of biased judgment for the original study.

Patient preferences for lifestyle behaviours in osteoporotic fracture prevention: a cross-European discrete choice experiment

Using a discrete choice experiment, we aimed to assess patients' preferences with regard to adopting lifestyle behaviours to prevent osteoporotic fractures. Overall, the 1042 patients recruited from seven European countries were favourable to some lifestyle behaviours (i.e., engaging in moderate physical activity, taking calcium and vitamin D supplements, reducing their alcohol consumption and ensuring a normal body weight).

INTRODUCTION

Alongside medical therapy, healthy lifestyle habits are recommended for preventing osteoporotic fractures. In this study, we aimed to assess patients' preferences with regard to adopting lifestyle changes to prevent osteoporotic fractures.

METHODS

A discrete choice experiment was conducted in seven European countries. Patients with or at risk of osteoporosis were asked to indicate to what extent they would be motivated to adhere to 16 lifestyle packages that differed in various levels of 6 attributes. The attributes and levels proposed were physical activity (levels: not included, moderate or high), calcium and vitamin D status (levels: not included, taking supplements, improving nutrition and assuring a minimal exposure to sunlight daily), smoking (levels: not included, quit smoking), alcohol (levels: not included, moderate consumption), weight reduction (levels: not included, ensure a healthy body weight) and fall prevention (levels: not included, receiving general advice or following a 1-day fall prevention program). A conditional logit model was used to estimate a patient's relative preferences for the various attributes across all participants and per country.

RESULTS

In total, 1042 patients completed the questionnaire. Overall, patients were favourable to lifestyle behaviours for preventing osteoporotic fractures. However, among the lifestyle behaviours proposed, patients were consensually not prone to engage in a high level of physical activity. In addition, in Ireland, Belgium, the Netherlands and Switzerland, patients were also not inclined to participate in a 1-day fall prevention program and Belgian, Swiss and Dutch patients were not prone to adhere to a well-balanced nutritional program. Nevertheless, we observed globally that patients felt positively about reducing their alcohol consumption, engaging in moderate physical activity, taking calcium and vitamin D supplements and ensuring a normal body weight, all measures aimed at preventing fractures.

CONCLUSIONS

In a patient-centred approach, fracture prevention should take these considerations and preferences into account.

[Effect and mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection]

Objective: To explore the role and specific mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection (ESD). Methods: Data of 81 patients [51 cases were male and 30 cases were female, aged (62.09±7.95) years] undergoing early esophageal cancer or precancerous lesions with a stripping range ≥3/4 circle hospitalized from January 2019 to February 2021 in Department of Gastroenterology, Zhongda Hospital, Southeast University. They were randomly divided into the control group (n=23), oral prednisone acetate group (n=28) and/or combined with local injection Triamcinolone acetonide group (n=30). Analysis the stenosis rates, endoscopic stent dilatation times, the scores of the Atkinson classification and QLQ-OES18 after 12 weeks. Also the expression of carbohydrate sulfotransferase15 (CHST15) mRNA, TGF-β1 and Collagen-Ⅰ protein were compared by real-time PCR or immunohistochemistry. Results: The stenosis rates of the control group, oral prednisone acetate group and/or combined with local injection Triamcinolone acetonide group were 82.6% (19/23), 46.4% (13/28) and 20.0% (6/30) (P<0.001); endoscopic stent dilatation times [M (Q₁,Q₃)] in these three groups were 2 (1, 3), 0 (0, 0) and 0 (0, 0) (P<0.001). After ESD, the scores of the Atkinson classification and QLQ-OES18 in the three groups were lower than before (P<0.001); and the expression of CHST15 mRNA in the three groups were 4.31±0.13, 3.44±0.07 and 2.84±0.21 respectively (P<0.001). Compared with the control group, the expression of CHST15 mRNA in oral prednisone acetate group was down-regulated (P<0.001), and was the lowest in oral prednisone acetate combined with local injection Triamcinolone acetonide group (P<0.001). As CHST15 mRNA was down-regulated, the expression of TGF-β1 and Collagen-I protein was also down-regulated (P<0.05). Conclusions: Oral prednisone alone or combined with local injection of triamcinolone acetonide both can prevent esophageal stenosis effectively. Oral combined with local injection of glucocorticoid is particularly more effective. Glucocorticoid can reduce the expression of CHST15 mRNA, thereby inhibiting the expression of TGF-β1 and Collagen-I protein.

Bragg coherent diffraction imaging of single 20 nm Pt particles at the ID01-EBS beamline of ESRF

This work demonstrates three-dimensional Bragg coherent diffraction imaging of single 20 nm Pt particles at the ID01-EBS beamline of ESRF.

Electronic or catalytic properties can be modified at the nanoscale level. Engineering efficient and specific nanomaterials requires the ability to study their complex structure–property relationships. Here, Bragg coherent diffraction imaging was used to measure the three-dimensional shape and strain of platinum nanoparticles with a diameter smaller than 30 nm, i.e. significantly smaller than any previous study. This was made possible by the realization of the Extremely Brilliant Source of ESRF, The European Synchrotron. This work demonstrates the feasibility of imaging the complex structure of very small particles in three dimensions and paves the way towards the observation of realistic catalytic particles.

Thomson scattering diagnostic system for the XuanLong-50 experiment

A 15-point Thomson scattering diagnostic system is developed for ENN's spherical torus experiment XuanLong-50 (EXL-50). A BeamTech laser with 3 J/pulse (1064 nm wavelength) at 50 Hz repetition rate is chosen for measurements during EXL-50 plasma operations. To enable measurements at low density (∼0.5 × 10¹⁸ m^-3) plasma operations, the opto-mechanical subsystems are carefully designed to maximize the collection and transmission of the scattered light and to minimize the stray light level. In addition, the high bandwidth trans-impedance amplifiers and segmented high speed waveform digitizers allow for the application of muti-pulse averaging to further improve the signal-to-noise ratio. Details of the diagnostic system are described and initial experimental results are presented.

[Analysis of serum immunoglobulin level in children with Burkitt lymphoma]

Objective: To summarize changes of serum immunoglobulin levels before and after chemotherapy in children with Burkitt lymphoma (BL), so as to investigate the effects of chemotherapy and rituximab on serum immunoglobulin levels in children with BL. Methods: Clinical data of 223 children with newly diagnosed Burkitt lymphoma at Beijing Children's Hospital from January 2009 to April 2017 were analyzed retrospectively. They were treated according to the modified LMB 89 regimen and some of them received combined rituximab therapy during the chemotherapy. The serum immunoglobulin (IgA, IgM, IgG) before chemotherapy, at the time of discontinuing chemotherapy, as well as 6, 12, 24, 36 months after chemotherapy were collected. Changes of serum IgA, IgM and IgG with time among different treatment groups were compared using repeated measures ANOVA. Results: According to risk group, 223 children were devided into group B（n=53）and group C（n=170）. Before chemotherapy, 109 cases (48.9%) were combined with hypogammaglobulinemia. The serum IgA, IgM, and IgG levels of all the patients were (0.9±0.7), 1.2 (0.5, 1.3) and (7.2±2.9) g/L before chemotherapy, (0.5±0.4), 0.2 (0.1, 0.3) and (6.3±2.3) g/L at the time of discontinuing chemotherapy (t=13.63, Z=-11.99, t=4.57, all P<0.05). There were statistical difference in IgA, IgM levels of group B and IgA, IgM, IgG levels of group C before chemotherapy and at the time of discontinuing chemotherapy (t=8.86, Z=-6.28, t=11.19, Z=-10.15, t=4.50, all P<0.05). The differences of serum IgA and IgG levels at the time after chemotherapy among patients treated with chemotherapy alone and those treated with chemotherapy combined rituximab in group B and C were significant (F=5.38, P=0.002 and F=4.22, P=0.007). Conclusions: Approximately half of children with BL have already existed hypogammaglobulinemia at initial diagnosis prior to the start of treatment. The modified LMB 89 regimen have significant effect on humoral immunity of children with BL. In the process of immune reconstruction after chemotherapy, rituximab has more significant effect on serum IgA and IgG levels in BL patients.

[Progress on clinical trials of common gastrointestinal cancer drugs in China from 2012 to 2021]

Objective: Systematically summarize the research progress of clinical trials of gastric cancer oncology drugs and the overview of marketed drugs in China from 2012 to 2021, providing data and decision-making evidence for relevant departments. Methods: Based on the registration database of the drug clinical trial registration and information disclosure platform of Food and Drug Administration of China and the data query system of domestic and imported drugs, the information on gastric cancer drug clinical trials, investigational drugs and marketed drugs from January 1, 2012 to December 31, 2021 was analyzed, and the differences between Chinese and foreign enterprises in terms of trial scope, trial phase, treatment lines and drug type, effect and mechanism studies were compared. Results: A total of 114 drug clinical trials related to gastric tumor were registered in China from 2012 to 2021, accounting for 3.7% (114/3 041) of all anticancer drug clinical trials in the same period, the registration number showed a significant growth rate after 2016 and reached its peak with 32 trials in 2020. Among them, 85 (74.6%, 85/114) trials were initiated by Chinese pharmaceutical enterprise. Compared with foreign pharmaceutical enterprise, Chinese pharmaceutical enterprise had higher rates of phase I trials (35.3% vs 6.9%, P=0.001), but the rate of international multicenter trials (11.9% vs 67.9%, P<0.001) was relatively low. There were 76 different drugs involved in relevant clinical trials, of which 65 (85.5%) were targeted drugs. For targeted drugs, HER2 is the most common one (14 types), followed by PD-1 and multi-target VEGER. In the past ten years, 3 of 4 marketed drugs for gastric cancer treatment were domestic and included in the national medical insurance directory. Conclusions: From 2012 to 2021, China has made some progress in drug research and development for gastric carcinoma. However, compared with the serious disease burden, it is still insufficient. Targeted strengthening of research and development of investment in many aspects of gastric cancer drugs, such as new target discovery, matured target excavating, combination drug development and early line therapy promotion, is the key work in the future, especially for domestic companies.

[Stereotactic body radiation therapy for patients with lung and liver oligometastases from colorectal cancer: a phase Ⅱ trial]

Objective: To explore the safety and effectiveness of stereotactic body radiation therapy (SBRT) for oligometastases from colorectal cancer (CRC). Methods: This is a prospective, single-arm phase Ⅱ trial. Patients who had histologically proven CRC, 1 to 5 detectable liver or lung metastatic lesions with maximum diameter of any metastases ≤5 cm were eligible. SBRT was delivered to all lesions. The primary endpoint was 3-year local control (LC). The secondary endpoints were treatment-related acute toxicities of grade 3 and above, 1-year and 3-year overall survival (OS) and progression free survival (PFS). Survival analysis was performed using the Kaplan-Meier method and Log rank test. Results: Petients from 2016 to 2019 who were treated in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Forty-eight patients with 60 lesions were enrolled, including 37 liver lesions and 23 lung lesions. Forty-six patients had 1 or 2 lesions, with median diameter of 1.3 cm, the median biologically effective dose (BED(10)) was 100.0 Gy. The median follow-up was 19.5 months for all lesions. Twenty-five lesions developed local failure, the median local progression free survival was 15 months. The 1-year LC, OS and PFS was 70.2% (95% CI, 63.7%~76.7%), 89.0% (95% CI, 84.3%~93.7%) and 40.4% (95%CI, 33.0%~47.8%). The univariate analysis revealed that planning target volume (PTV) and total dose were independent prognostic factors of LC (P<0.05). For liver and lung lesions, the 1-year LC, OS and PFS was 58.7% and 89.4% (P=0.015), 89.3% and 86.5% (P=0.732), 30.5% and 65.6% (P=0.024), respectively. No patients developed acute toxicity of grade 3 and above. Conclusion: SBRT is safe and effective treatment method for oligometastases from CRC under precise respiratory motion management and robust quality assurance.

[Trend and prediction of hepatitis C cases in children aged 14 years old and younger in Henan province, 2005-2020]

Objective: To explore the time series characteristics of hepatitis C cases in children aged ≤14 years old in Henan and predict their epidemic situation with effective model. Methods: Hepatitis C reported data among children aged ≤14 years old in Henan from 2005 to 2020 were collected from China information system for diseases control and prevention. Descriptive and time series analyses were used to demonstrate characteristics of time trend, decomposition methods were used to show the seasonality by using seasonal indices and the long-term trend by using a linear regression model. An auto-regressive integrated moving average (ARIMA) model was established. Results: From 2005 to 2020, a total of 5 355 hepatitis C cases in children were reported in Henan, the seasonal index range of the hepatitis C was lower than 1, and no obvious seasonality characteristics was observed. The average of monthly incidence of 2005-2011 showed increase trend (0.351 case/month), and the incidence of 2012-2020 decreased (-0.474 case/month). The predicted reported case number of hepatitis C in children in Henan from January 2005 to December 2020 fitted by ARIMA model was consistent with the actual number, the RMSE of the number of reported cases in the current year and the existing number of children cases was 10.240, 10.558, the MAPE was 35.566, 0.659, and the MAE was 6.688, 7.156, respectively. Conclusion: Time series analysis on surveillance data is useful for the better understanding of the epidemic situation of hepatitis C in children aged ≤14 years. ARIMA model can be used in the short-term prediction and dynamic analysis of the incidence of hepatitis C in children in Henan.

[Clinicopathological features of congenital hemangioma: a study of 40 cases]

Objective: To investigate the clinical and pathologic features, diagnosis and differential diagnosis of congenital hemangioma (CH). Methods: Forty cases of CH were diagnosed from January 2017 to December 2020 in Henan Provincial People's Hospital. The clinical and pathological and immunohistochemical data were analyzed, with review of literature. Results: There were 24 male and 16 female patients. The lesions were located in the head, neck (11 cases), limbs (14 cases), and trunk (15 cases). The clinical manifestations were congenital painless plaques or masses, the larger ones protruded on the skin surface, mostly dusky purple or bright red, with surrounding white halos. Under low magnification, the tumor was lobular and well demarcated, composed of neo-microvascular lumen of different sizes. The vascular endothelial cells were cuboidal or hobnail in appearance, forming stellar drainage vessels within the lobules. Extra-medullary hematopoiesis was seen in one case of rapidly involuting CH; there were different number of tortuous and dilated vascular lumen between the lobular structures, and some non-involuting CH cases were vascular malformations, which were devoid of lobulated structures. Immunohistochemistry showed that endothelial cells were strongly positive for CD31, CD34 and ERG, while D2-40 and GLUT-1 were negative. Conclusions: CH is a benign congenital vascular tumor with characteristic lobulated growth and abnormal blood vessels in the stroma. Pathological diagnosis often needs to be differentiated from infantile hemangioma, pyogenic granuloma, kaposiform hemangioendothelioma and vascular malformation.

Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study

This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline.

INTRODUCTION

To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV).

METHODS

Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV.

RESULTS

A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: - 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations.

CONCLUSION

The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.

Tyrosine Sulphation of CXCR4 Induces the Migration of Fibroblast in OSF

Oral submucous fibrosis (OSF) caused by areca nut chewing is a prevalent fibrotic disease in Asia-Pacific countries. Arecoline-induced migration of fibroblasts (FBs) plays a vital role in the development of OSF. However, the specific molecular mechanisms involved remain unclear. Many studies have shown that tyrosine sulphation of chemokines can influence cell migration. Herein, we demonstrated that arecoline stimulates tyrosine sulphation of the chemokine receptor 4 (CXCR4) through the tyrosylprotein sulphotransferase-1 (TPST-1) to enhance the migration ability of FBs. Moreover, by RNA-Seq analysis, we found that the most significantly altered pathway was the EGFR pathway after the arecoline stimulation for FBs. After the knockdown of arecoline-induced EGFR expression, the tyrosine sulphation of CXCR4 was significantly decreased by the inhibition of TPST-1 induction. Finally, in human OSF specimens, TPST-1 expression was directly correlated with the expression of CXCR4. These data indicate that the arecoline-induced tyrosine sulphation of CXCR4, which is regulated by TPST-1, might be a potential mechanism that contributes to FB migration in OSF.

[Effects of postoperative urine protein levels on predicting acute kidney injury in critically ill patients undergoing non-cardiac surgery]

Objective: To investigate the predictive value of postoperative urine protein level in critically ill patients undergoing non-cardiac surgery with acute kidney injury (AKI). Methods: A total of 661 critically ill patients undergoing non-cardiac surgery, who visited the Department of Critical Care Medicine of Peking University First Hospital from May 20, 2019 to November 24, 2020, were enrolled in this prospective study. The clinical data of the patient's age, gender, body mass index, laboratory examination, surgical status, etc. were collected. AKI diagnostic criteria of the 2012 KDIGO guidelines were used to diagnose the occurrence of AKI after surgery. The independent predictors of AKI were determined by multivariate logistic regression. Results: The age of this patient cohort was (69±15) years. The prevalence of AKI was 45.4% (300/661). Multivariate logistic regression showed that urine protein semi-quantitative ≥2+(OR=2.62, 95%CI: 1.05-6.56, P=0.039) was independent factor for postoperative AKI in critically ill patients undergoing non-cardiac surgery, other independent factors include higher age (OR=1.04, 95%CI: 1.02-1.06, P=0.001), higher body mass index (BMI) (OR=1.12, 95%CI: 1.04-1.21, P=0.004), lower plasma hemoglobin level (OR=0.98, 95%CI: 0.97-1.00, P=0.019), lower central venous pressure (OR=0.89, 95%CI: 0.83-0.97, P=0.005) and lower total hypotension time (OR=1.01, 95%CI: 1.00-1.01, P=0.041). Conclusions: Urine protein semi-quantitative ≥2+after surgery is an independent predictive factor for the occurrence of postoperative AKI in critically ill patients undergoing non-cardiac surgery. It is important to check urine routine immediately after surgery to detect and deal with high-risk patients.