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 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.

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 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.

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 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.

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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 clarify the clinical significance and prognoses of critical patients with hyperglycemia incurred by various causes. Method A total of 826 critical patients were enrolled during the period from October 2006 to November 2007, and blood sugar was measured by using rapid testing devices within the first hour after admission. If blood sugar measured was more than 11.1 mmol/L, the diagnosis of hyperglycemia was made, and furthermore, glycosylated hemoglobin (GHb) was detected as well. The diagnosis of hyperglycemia was made in 651 critical patients and those patients were followed up for 28 days to confirm the diagnosis. According to the levels of GHb, they were divided in two groups, namely normal GHb and high GHb groups. Each group was further divide into two subgroups, namely diabetes group and non -diabetes group in order to compare the fatality rate between the two groups. Results There were 385 patients diagnosed to have diabetes and among them, 155 patients had no clear history of diabetes, accounting for about 23.81% of the 651 hyperglycemia patients. There were 266 (40.86% ) patients were diagnosed to have stress induced hyperglycemia, The fatality rate of 28 - day in the high GHb group was higher than that in the normal GHb group (12. 23% vs 5. 82% , P = 0.001) . In the high GHb group, the fatality rate of 28-day in the patients without clear history of diabetes was higher than that in the patients with clear history of diabetes (19.21% vs7.11%, P =0. 000). Conclusions The hyperglycemia found in critical patients could not be all attributed to the stress induced hyperglycemia especially in the patients without clear history of diabetes, and the prognoses of patients with variously causal hyperglycemia were various.

ObjectiveTo investigate the treatment effects of comprehensive nursing intervention on patients with chronic obstructive pulmonary disease(COPD) treated by non-invasive mechanical ventilation with BiPAP mode.Methods96 patients with diagnosed COPD and using non-invasive mechanical ven- tilation with BiPAP mode were randomly divided into the control group(46 cases) which was treated with routine measures and the comprehensive nursing intervention group (50 cases) which adopted comprehen- sive nursing intervention according to experimental design. The frightening degree, incidence rate of com- plications and clinical treatment effect by ventilator were compared between the two groups.ResultsPa- tients compliance with treatment and clinical treatment effect by ventilator in the comprehensive nursing in- tervention group was better than that of the control group. The frightening degree and incidence rate ofcomplications were lower than those of the control group (P < 0.01 ).ConclusionsComprehensive nurs-ing intervention with non-invasive mechanical ventilation with BiPAP mode can improve the treatmentcompliance of COPD patients,reduce complications followed by non-invasive mechanical ventilation andreach the prospective treatment effect.