Objective To investigate the relationship between the colloid osmotic pressure (COP) as well asosmolality and the outcomes of critical patients. Method Totally 1568 critical patients were chosen from emergen-cy intensive care unit and surgical intensive care unit in Chaoyang Hospital Affiliated to Capital Medical Universityfrom January 2002 to December 2005, and divided into different groups according to levels of COP and osmolality.In group program Ⅰ, all patients were divided into 2 subgroups based on COP (the critical value was 20 mmHg =1.2 mOsm/kg H2O)on the day of admission. In group program Ⅱ, the same patients were divided into 3 sub-groups based on osmolality (the critical value was in the range from 280 mOsm/kg H2O aad 310 mOsm/kgH2O)which was also measured on the day of admission. The mortality of patients was calculated. Chi-square test wasused. Results Compared with patients of normal colloid osmotic pressure group, patients of lower colloid osmoticpressure group had higher mortality(24.5% vs. 17.7%, P = 0.001). Compared with the patients of normal os-molality group, the patients of lower total osmotic pressure group had lower mortality(17.0% vs. 24.5%, P =0.000). Conclusions Compared with the normal osmolality, the normal colloid osmotic pressure had the moreclosely relationship with the outcomes of critical patients, and it maybe a predictor of prognosis of the critical pa-tients.

Objective To investigate the therapeutic effects of injectio xuebijing (Chinese herb prepara-tions) on coagulat factors in dogs with septic shock. Method Eighteen dogs infected and shocked by intravenous endotoxin(LPS) were randomly divided into three groups: control group (n=6) treated with sodium chloride, dopamine group (n=6) treated with dopanfine, and dopamine plus xuebijing group (n=6) treated with dopamine and xuebijing. The therapeutic effects were assessed by comparison of the changes in VCAM (vascular cell adhe-sion molecule) ,ICAM (inter-cell adhesion molecule), VWF (yon willibrand factor) and PAI-I (plasminogen acti-vator inhibitor-1) at different indexes including the basic status, the dog being shocked without therapy, 3 and 7 hours after treatment.Analysis was made by SPSS 13.0 software. Results In xuebijing group, VCAM, ICAM, VWF and PAI-1 were signifieanfly changed 3 or 7 hours later after xuebijing administered rather than in control group and dopamine group (P<0.01 or P<0.05 ).In dopamine group, ICAM,VWF and PAI-1 were signiti-eanfly changed 3 or 7 hours after dopamine given rather than in control group (P<0.01 or P <0.05). Conclu-sions Injectio xuebijing obviously decreases the levels of coagulat factors in dogs with septic shock. Therfore, the injectio xuebijing can be used to treat the septic shock.

ObjectiveTo explore the prognosis and relationship between soluble differentiation antigen of cluster designation 14 (sCD14) and the injury severity score (ISS) of casualties with multiple injuries.Methods A total of 86 casualties with multiple injuries were enrolled from October 2009 to March 2010,and the severity of trauma of casualties were assessed in ISS score within the first 24 hours after accident,and the patients were divided into survival and non-survival groups as per the outcomes in 28 days after accident. Another 20 healthy subjects served as control group. In multiple injuries group,sCD14 concentrations were detected and APACHE Ⅱ scores were calculated on the 1st,3rd,5th and 7th days after accident.The related coefficient between sCD14 and ISS was calculated and then the values of sCD14 in predicting prognosis were analyzed by ROC curve. ResultsCompared with control group, sCD14 concentrations were obviously higher in casualties of multiple injuries group at all observation intervals ( P ＜0.01). Compared with survival group, casualties of non-survival group had more higher sCD14 concentrations and APACHE Ⅱ scores ( P ＜ 0.05 ).The sCD14 concentration was correlated with ISS and the related coefficient was 0.469 ( P ＜ 0.01 ). ROC curve analysis suggested sCD14 had values in predicting prognosis of casualties with multiple injuries and area under ROC curve was 0.820.Conclusions The concentration of sCD14 is correlated with ISS and can be used for predicting the prognosis of casualties with multiple injuries.

Objective To investigate the effect of common diseases by the Charlson weighted index of comorbidities(WIC) in predicting 1-year survival rate of older patients with rectum cancer.Methods Retrospective analyzed 160 patients with rectum cancer who were admitted in general surgery of Beijing Chaoyang Hospital Affiliated to Capital Medical University from Jun.2011 to May 2012.The patients were divided into two groups according to 1-year survival status:survival group (n =123) and death group (n =37).The data were recorded including age,gender,cancer diagnosis,underlying diseases,operation mode (laparoscopic or open) The WIC and the Acute physiology and chronic health Ⅱ (APACHE Ⅱ) score were calculated.Logistic regression analysis was used to determine the independent predictors for 1-year survival rate.Receiver operating characteristics(ROC) curve was used to evaluate the value of WIC in predicting 1-year survival rate.Results Of the 160 patients,123 cases survived,37 cases died at 1 year after treatment.WIC score and APACHE score in death group were (2.2 ± 1.3) and (11.5 ± 5.1),higher than those of survival group (1.3 ± 1.2,9.5 ± 4.3 ;P =0.021,0.014).Multivariate Logistic regression analysis indicated that age,mode of operation,WIC score and APACHE score were related to the 1-year survival status of patients with rectal cancer(OR(95％ CI):1.053 (1.018-1.178,1.021 (1.011-1.906),1.786 (1.203-2.235),1.019 (1.004-1.628).ROC curve area of forecasting of death of the WIC score,APACHE Ⅱ score and the combination of the two are 0.731,0.828,0.959.Conclusion The WIC scoring system can be a good evaluation method for 1-year survival rate in old patients with rectum cancer.

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Objective To explore the clinical significance of carrying out fast blood B-type natriuretic peptide ( BNP) detection together with noninvasive hemodynamic monitoring for pathogenic diagnosis in patients with dyspnea and to assess further the application value of noninvasive cardiac output monitoring in emergency room.Methods 354 patients were diagnosed as dyspnea in the Emergency Department of Chaoyang Hospital, being Affiliated to Capital Medical University during a period from May 2007 to January 2008 by using USCOM noninvasive ultrasonic cardiac output monitor to measure cardiac output ( CO).If CO was less than 4 L/min, cardiac dyspnea will be diagnosed.Meanwhile, certain amount of venous blood was kept for rapid measuring of BNP concentration.If BNP concentration was higher than 100 pg/ml, cardiac dyspnea would be diagnosed.After diagnosis was made clearly, all the 354 patients were divided in two groups according to Framingham standards whether they had cardiac dyspnea or not and then comparison was carried out between the patients with the diagnosis of cardiac dyspnea with CO and BNP.The relationship between CO and BNP was studied as well.Results In a group of 127 patients with cardiac dyspnea, there was no difference in terms of the number of patients showing positive results with CO or BNP as judging criteria (122 vs 119, P =0.393) and CO and BNP had negative correlation; while the results were opposite in a group of 227 patients with non-cardiac dyspnea (102 vs 11, showing negative CO or BNP P = 0.000) and there was no correlation between BNP and CO.Conclusions For patients with dyspnea in the emergency room, the value of BNP concentration of blood plasma to determine cardiac dyspnea is somewhat limited.Appling non-invasive ultrasonic cardiac output monitor in the emergency room to detect CO for identifying the cause of dyspnea is clinically valuable.

Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.

Objective To investigate the prognosis evaluation of acute kidney injury (AKI) by kidney disease staging of Improving Global Outcomes Organization (KDIGO) criteria and neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis patients treated with continuous blood purification (CBP).Methods In this prospective study, 84 severe sepsis patients treated with venous-venous CBP were selected from January 2013 to December 2014 in emergency intensive care unit of Medical University of China, Shun Yi Hospital and were divided into 3 groups based on the KDIGO staging criteria.Blood NGAL, ICU survival rate and renal function outcome of survivals were compared among groups.Results Compared with KDIGO stage 3, KDIGO stages 1 and 2 hospitalized patients had significantly lower NGAL [(453.9 ± 74.4) ng/mL vs.(789.1 ±86.8) ng/mL, P ＜0.01];Hospitalized survival rate was 92.3％ (24/26) in KDIGO stages 1 and 2 which was significantly higher than 69.0％ (40/58) in KDIGO stage 3 (P =0.026).Renal function improvement rate in KDIGO stages 1 and 2 was significantly higher than that in KDIGO stage 3 [83.3％ (20/24) vs.27.5％ (11/40), P ＜0.01].When the reliability of combination of KDIGO criteria and NGAL for prognosis evaluation was analyzed by ROC curve, the area under curve of survival was 0.703 (95％ confidence interval: 0.648-0.759, P ＜0.01) and area under curve of renal function improvement was 0.679 (95％ confidence interval: 0.627-0.731, P ＜ 0.01).Conclusions In severe sepsis patients complicated with AKI, CBP in KDIGO stages 1 and 2 might improve survival rate and renal function of sepsis patients.Combination of KDIGO criteria and NGAL maybe acted as an indicator of the prognosis in severe sepsis patients with complication of AKI.

Objective To determine the protective effect of isosorbidemononitrate (IM) on myocardial injury after restoration of spontaneous circulation (ROSC)in swine models of cardiac arrest induced by ventricular fibrillation.Methods The experiment was carried out in Animal Lab of Beijing Chao-Yang Hospital,Capital Medical University.Ventricular fibrillation was induced and untreated for 8 min in twenty WhuZhiShan piglets.CPR was performed until ROSC occurred.The animals were randomized (random number)into two groups:IMgroup (n =10)and control group (n =10).IM [2 μg/(kg· min)]or the equivalent volume in saline was administered respectively for 6 h after ROSC.Hemodynamics and post-resuscitation cardiac function were monitored until 24 h after ROSC. Echocardiography and transmission electron microscopy were useed at 72 h after ROSC.Results There was no significant difference in survival rate between the two groups.No significant differences in mean arterial pressures (mmHg)at ROSC 6 h (88.5 ±5.6 vs.87.8 ±6.0,P =0.790)and ROSC 24 h (89.3 ±3.8 vs.86.9 ± 5.0,P =0.245)between the two groups were found.Cardiac outputs (L/min)were significantly increased at ROSC 6 h (2.40 ±0.17 vs.1.60 ±0.14,P <0.01)and ROSC 24 h (2.49 ±0.17 vs.2.09 ±0.21,P<0.01);and ejection fraction at ROSC 72 h (0.67 ±0.08 vs.0.56 ±0.09,P =0.044)was improved too,and significant differences were found between the two groups.The ultra-structural myocardial injury was ameliorated in the MI group at 72 h after CPR observed by using electron microscopy.Conclusions IM can ameliorate post-resuscitation cardiac dysfunction in porcine models of cardiac arrest induced by ventricular fibrillation.

Objective To identify the clinical significance of low triiodothyronine syndrome and the potential impact of triiodothyronine (T3) on prognosis in critical patients.Methods A total of 150 critically ill patients enrolled from October 2012 to April 2013 were divided into two groups,namely low thyroidhormone group (n =38,group A) and normal T3 group (n =112,group B).APACHE Ⅱ scores of patients were recorded at admission and thyroid hormone levels were measured on the first and the third day after admission.Then the survival state of 28-day in each group was observed and then the relationship between prognosis and T3 levels was analyzed by receiver operating characteristic (ROC) curve.Results About 25.3％ of 150 critical patients were suffered from low thyroidhormone syndrome and the mortality rate in this group was 42.1％,which was much higher than 29.5％ in normal T3 group.There was no difference in prediction of death rate analyzed by ROC curve between the T3 level and APACHE Ⅱ scores.The area under curve of T3 level was 0.768 (95％ CI:0.701-0.835) and APACHE Ⅱ was 0.783 (95％CI:0.719-0.846).Best cut-off value of T3 level was 0.41 ng/mL resulting in 76.6％ sensitivity and 78.4％ specificity.Conclusions Critically ill patients complicated with low thyroidhormone syndrome has poor prognosis and T3 may be a predictive marker in evaluating the prognosis of critically ill patients.