This article has reviewed the invasion,prevention and cure situation and the latest research progresses of "bird flu"(flu carried by birds: found in Hong Kong in late 1997)with high pathogenicity on human beings in Hong Kong since 1997.By analyzing the invasive regularity of "bird flu"on human beings with the theory of traditional Chinese medicine,it was considered that H5N1 virus was attributed to the "fire" "smelly"poison,the epidemic poison got into the human body from the mouth,noses,and eyes.It attacked the lung first,and then got down to the stomach and intestine,direct attack of pericardium,consumption of body-fluid with wind symptom.It mainly attacked the children,youths and adults in crowd.Clinically,state of evil domination considered as sthenia-syndrome was the common disease type.The author studied out the modified Puerariae and Scutellariae and Coptidis Decoction as the main reference formula in treating "bird flu"with high pathogenicity on human beings and avians.

Objective To study the relationship between magnetic resonance imaging (MRI)of rheumatoid arthritis (RA)and traditional Chinese medicine (TCM)syndrome types.Methods 90 patients with RA were select-ed as the research subjects.Through 2 attended doctors more strict according to the specific diagnostic criteria of the syndrome,the implementation of the diagnosis of TCM syndromes.The conventional treatment of the patients were recorded,and the X line of the two hands joint was obtained by double blind reading.At the same time,the relevant symptoms and symptoms of the laboratory and other related information were analyzed.Results Of 90 RA patients, 22.22% patients were cold dampness stasis type,27.78% patients were damp heat blocking collaterals,26.67%patients were cold and heat syndromes,23.33% patients were deficiency of liver and kidney and phlegm stasis stasis type.Patients after the initial diagnosis,hands joint implementation hands joint side position was detected by MRI,the MRI results showed thickened synovium,bone erosion,bone marrow edema and joint effusion,and the constituent ratio of MRI images had significant difference (χ2 =13.372,P <0.05).Four TCM syndrome types of RA patients,after treatment,again implement hands joint anteroposterior and lateral radiographs of the MRI detection,after detection of radiology hands joint MRI detection results showed that implementation stage and detailed records,and at the time of initial diagnosis.The patients'hands joint MRI examination test showed that the control,any bone damage intensifies, the MRI signs of more serious progress.However,impaired bone level unchanged,MRI without aggravate was not changed.Conclusion For RA patients,MRI manifestations and TCM syndrome type has relationship.At early stage of the disease,active and reasonable use of anti -rheumatic drug treatment to improve the condition of RA can reduce the morbidity.

Objective To study the autonomic nervous regulation function,and to study relationship between heart rate variability and severity,organ dysfunction and prognosis in patients with systemic inflammatory response syndrome (SIRS).Methods All the patients were divided into two groups:SIRS and non-SIRS according to the criteria of SIRS. The SIRS group included 100 patients and the non-SIRS group 30 patients,and the control group included 30 heathy adults. SIRS group was further divided into two subgroups:survivor and succumbed.Heart rate variability(HRV)was analyzed with the two methods of time-domain and frequency-domain.Results The SIRS group had significantly higher APACHEll scores and MODS scores(P＜0.01)and lower HRV when compared with the non-SIRS group(P＜0.05).In the SIRS group,the succumbed groupallad statistically higher APACHEII and MODS scores and lower HRV than the survivor group( P＜0.01).There was a negative correlation between the prognosis of the patients and SDNN(r=-4.68,P＜0.01), SDNN＜55 ms was the most sensitive(76.2%),and specific(76.7%),with positive predictive value(90.4%)and negative predictive value(52.6%).Conlusion The SIRS patients had lower HRV,and there was a negative correlations with the severity of disease,organ dysfunction and prognosis.HRV(SDNN)were the useful index to evaluate the prognosis of critically ill patients.

Objective To investigate the feasibility of SAPS 3-PIRO score for prediction of outcomes in severe sepsis patients in the intensive care units (ICU).The optimal scoring system was also evaluated in this study.Methods Data of 677 patients with sepsis,treated in ICU of the emergency department at the Beijing Chaoyang Hospital between January 2008 and December 2011,were analyzed.The inclusion criteria were:age ≥18 years and the diagnostic criteria of severe sepsis and organ damage recommended by the International Sepsis Definitions Conference in Washington DC,USA in 2001,as well as the criteria developed by the Conference as a reference.The patients,who did not meet the criteria were excluded from the study.Age,gender,underlying disease,main infection site,and duration of ventilator support of all cases were recorded.Vital signs,hematological findings (gases,biochemistry,coagulation) and causative pathogens and organ damage on day-1 in the ICU were also recorded.According to the data of the most unfavorable findings in the ICU on day-1,scores got from APACHE Ⅱ,SOFA (sequential organ failure assessment),SAPS Ⅲ(simplified acute physiological score Ⅲ),SAPS 3-PIRO (predisposition,infection,response,organ failure/dysfunction) and MEDS (mortality in emergency department sepsis score) scoring systems were calculated.All patients were followed up for 28 days.The outcome of survival and death at 28 days were the endpoints of this study.SPSS V13.0 (SPSS,Chicago,IL,USA) was used to analyze data.Continuous variables with normal distribution were expressed as mean ± standard deviation.The independentsample t test was applied when normality (and homogeneity of variance) assumptions were fulfilled otherwise the t' test would be used.The distribution of categorical variables in two groups was tested using the x2 test.Binary logistic regression models were also used according to the survival status.The values of scoring system in predicting outcomes and the determination of dividing value in predicting death were analyzed using receiver operating characteristic (ROC) curves.The area under the receiver operating characteristic (AUROC) curves was compared using Z test.P values less than 0.05 were considered statistically significant.Results The total 28-day mortality was 41.9％.APACHE Ⅱ,SOFA,SAPS Ⅲ,SAPS 3-PIRO and MEDS scoring systems were used to find the independent predictive factors of death within 28 hours in patients with severe sepsis.By using ROC curve and AUROC curve to compare the validity of these scoring systems,SAPS 3-PIRO score had comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ scores,and MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score.Conclusions For patients with severe sepsis admitted in ICU,MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score in predicting prognosis.MEDS has favorable capability in predicting death within 28 days.MEDS ≥ 11 was the sign of increased mortality.SAPS 3-PIRO score has comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ score and it may be suggested for clinical practice.

Objective To investigate the power of the simplified acute physiology score Ⅲ ( SAPSⅢ) for prediction of outcome for patients with severe sepsis admitted to the intensive care unit ( ICU ). Methods A retrospective study was conducted. 677 severe sepsis patients with age ≥ 18 years old and the survival time in emergency ICU≥24 hours admitted to the emergency ICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2008 to December 2011 were enrolled. The acute physiology and chronic health evaluationⅡ ( APACHEⅡ), sequential organ failure assessment ( SOFA ), SAPSⅡ, SAPSⅢ, and mortality in emergency department sepsis ( MEDS ) scores were recorded based on the poorest value within 24 hours of ICU admission. The 28-day result as denoted as survival or death was considered as the end point of the study. The ability to predict mortality by the score systems was assessed by using receiver operating characteristic ( ROC ) curve analysis and binary logistic regression models. Results Among the 677 patients with severe sepsis, 284 cases died within 28 days after admission, and the mortality rate was 41.9%. Compared with survivors, the patients in non-survival group was older with higher APACHEⅡ, SOFA, SAPSⅡ, SAPSⅢ, and MEDS scores and higher ratio of underlying diseases, such as primary hypertension and renal dysfunction, and they had more organ injury, higher ratio of lung infection and bacterial infection ( P < 0.05 or P < 0.01 ). It was identified by logistic regression that the APACHEⅡ, SOFA, SAPSⅡ, SAPSⅢand MEDS scores were significantly independent factors in 28-day death prediction in patients with severe sepsis ( all P=0.000 ). The rank of areas under the ROC curve ( AUC ) from high to low were MEDS ( 0.970 ), APACHEⅡ( 0.893 ), SAPSⅢ ( 0.875 ), SOFA ( 0.871 ), and SAPSⅡ ( 0.860 ), respectively. SAPSⅢ score and APACHEⅡ, SOFA, SAPSⅡscores were found to have an equivalent capacity in predicting the prognosis ( all P>0.05 ). The MEDS score in predicting the prognosis was obviously better than that of APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores ( all P<0.05 ). The MEDS score showed the best sensitivity ( 91.5%), and specificity ( 89.1%). The 28-day mortality in cases of MEDS≥11 was 85.8%. Conclusions ①For patients with severe sepsis who were admitted to ICU, MEDS was superior to APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores in predicting prognosis. MEDS≥11 may indicate a higher mortality rate.②SAPSⅢscore has comparable predictive capability with APACHEⅡ, SOFA and SAPSⅡscores may be recommended for prediction of the prognosis of patients with severe sepsis in ICU. But the SAPSⅢscore is unsuitable for predicting the prognosis of patients with acute sepsis in ICU options, and it is not superior to that of SAPSⅢscore in predicting prognosis of patients with sepsis in the emergency ICU than other score systems.

Objective To study the changes of vascular endothelial functional status and cytokine TNF-α in patients with multiple organ dysfunction syndrome (MODS).Methods Plasma levels of tissue plasminogen activator (t-Pa), plasminogen activator inhibitor-1 (PAI-1 ), circulating endothelial cell (CEC) and serum levels of endothelin (ET-1), tumor necrosis factor- ( (TNF-α), nitric oxide (NO) were determined serially dynamically in patients with MODS and those without MODS (non-MODS). At the same time Marshall scores were evaluated.Results Blood levels of TNF-α, ET-1, PAI-1, CEC, and Marshall scores were significantly higher in MODS and succumbed (those who died) groups than those in non-MODS and survied (those who lived) groups (P ＜ 0.05), but blood levels of NO and t-Pa were significantly lower ( P ＜ 0.05).Conclusion TNF-α played an important role in the progression of MODS. The increase of ET-1, PAI-1, CEC and the decrease of NO and t-Pa indicated endothelial dysfunction in MODS. Marshall scoring system for MODS was a sensitive parameter in evaluating the patients with MODS.

Objective To evaluate the effectiveness and advantage of the TruviewTM EVO2(R) optical laryngoscope in comparison with the commonly used laryngoscope for the endotracheal intubation in patients in the emergency setting. Method Thirty-six patients in need for emergency endotracheal intubation in our hospital from February to May 2009 were randomly assigned to give intubation by using a TruviewTM EVO2(R) optical laryngoscope (T group) or a commonly used laryngoscope(R group). Cormack and Lehane laryngoscope grade (the degree of exposure of glottis by using laryngoscope), IDS (Intubation Difficulty Scale) score, the time taken for successful intubation, lowest SpO2 and the complication during intubation were essential factors for comparison between two groups. Results Our data showed that there was no difference in duration of the successful endotracheal intubation attempts between these two groups (respectively 22.73 ± 7.66 s and 19.91 ± 8.03 s, P ＞ 0. 05). However, the glottis exposure condition was significantly improved with TruviewTM EVO2(R) optical laryngoscope (P ＜ 0.01). The average IDS score for patients in T group was 0.33 ± 0.49, which is much lower than those in the R group (4.11± 0.90, P ＜ 0.01). In addition, the average SpO2 value measured in T group during the intubation operation was significantly higher than that in R group (98.87±0.74% and 91.45 ±4.86% respectively, P ＜0.01) and there was less complication observed in patients of T group. Conclusions Using TruviewTM EVO2(R) optical laryngoscope for emergency endotracheal intubation could help to expose the glottis in an ideal view, predominately lower the C/L grade and thus decrease the difficulty in intubation for clinicians. Its specially designed oxygen supplier allows the SpO2 to be maintained at a high level during the operation as well as reduce the incidence of complication. It is therefore extremely useful for emergency tracheal intubation, particularly a difficulty intubation situation.

Objective To observe the myocardial injury attributed to cardiopulmonary resuscitation, and to evaluate the impact of 4 ℃ saline perfusion on the ultra structure of myocardium. Method Twelve Pekimg white swine were induced to make models of ventricular fibrillation by direct current shock. Cardiopulmonary resuscitation was initiated 4 minutes after ventricular fibrillation established, and 10 swine survived from resuscitation. These swine were randomly(random number ) divided into hypothermia group ( n = 5) ( 4 ℃ saline infusion to lower the temperature) and control group ( n = 5). Haemodynamics were monitored. And ultra structure of myocardium was observed under electron microscope 24 hours later. The Mann-Whitney test was used to compare the consecutive variables of 2 samples. Results The damage to the ultra structure of myocardium, myofilaments and mitochondria, was found in the control group, while that to a much lesser extent in the hypothermia group was observed. Conclusions After cardiopulmonary resuscitation, 4 ℃ saline infusion has a protective effect on myocardium.

Objective To assess the effects of hypothermia induced by 4 ℃ normal saline (NS) on biochemical function, enzymology and morphology of liver in swine after the success of cardiopulmonary resuscitation (CPR) for cardiac arrest(CA). Method The swine were resuscitated with standard CPR 4 minutes after ventricular fibrillation(VF) ,and the survived swine were randomly(random number) divided into two groups. In hypothermia(LT) group (n = 5), swine were treated with continuous infusion of 4 ℃ NS at the speed of 1.33 mL/(kg·min) for 22 min, and then slow the speed to 10 mL/(kg·h) for 4 h. In normothermia (NT) group ( n= 5) swine were treated with the infusion of NS with room temperature instead of cryogenic NS at the same speed as the LT group. The hemodynamics and the changes of blood gas were monitored until 4 h after restoration of spontaneous circulation (ROSC), and blood samples were taken to detect serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) before VFand 10 min, 2 h and 4 h after ROSC. All swine were sacrificed 24 hours after ROSC, and their liver tissues were taken away for detecting Na+ -K + -ATP enzyme and Ca2+ -ATP enzyme as well as the histological changes under both light and electron microscopy. ResultsThe heart rate, MAP, cardiac output(CO) and coronary perfusion pressure(CPP) of swine were stable in LT group ( P ＞ 0.05). The AST, ALT and LDH increased in both groups but less in LT group. The hepatic ATP enzyme activity was much higher in LT group ( P ＜ 0.05). Compared with the NT group, there were less cellularedema,necrosis or inflammatory cells infiltration, and better morphosis of mitochondria of livers found in swine of LT group. Conclusions The continuous administration of 4 ℃ NS after ROSC could quickly lower the core body temperature, and it could keep hemodynamics and oxygen metabolisms stable, protecting the biochemical function,enzymology and morphology of liver in swine after CPR.

ObjectiveTo assess the sepsis score used for detecting the mortality of patients with sepsis in emergency department, and to compare with APACHE Ⅱ score, simplified acute physiology Ⅱ score ( SAPS Ⅱ ) and modified early warning score (MEWS) in terms of 28-day mortality of patients. Methods A total of 613 patients with sepsis were enrolled from the emergency department for a prospective study from September 2009 to September 2010. The sepsis score, APACHE Ⅱ score, SAPS Ⅱ score and MEWS score all were recorded and compared. The patients with sepsis were followed up for 28 days. Based on the sepsis score, patients with sepsis were stratified into 5 mortality risk groups, namely very low risk group (0～4 points), low risk group (5 ～7 paints), moderate risk group (8 ～ 12 points), high risk group ( 13 ～ 15points) and very high risk group (more than 15 points). The actual mortality rates were compared among all 5 groups by using Chi square test. Then, comparison between survivors and non-survivors carried out with logistic regression analysis to determine the independent risk factors of mortality.Receiver operating characteristic curve (ROC curve) was used to compare the sepsis score with APACHE Ⅱ score, SAPS Ⅱscore and MEWS in respect of the prognosis validity. ResultsTen patients were out of the follow-up and the data of 603 patients followed up were completely documented. The actual mortality rates of 5 risk groups were 0％, 7.7％, 18.5％, 46. 7％ and 63％, respectively. There were significant differences in age and four scoring systems between survivors ( n = 440) and non-survivors ( n = 163 ) ( P ＜ 0. 01 ). Sepsis score,APACHE Ⅱ score, SAPS Ⅱ and MEWS all were valid and eligible for detecting the risk of mortality in patients with sepsis. The ROC areas under the curve (AUC) of these 4 scoring systems were 0. 767, 0. 743,0. 741 and 0. 636, respectively. ConclusionsThe sepsis score can be used to stratify patients with sepsis according to mortality risk with better sensitivity to predict 28-day mortality. It is rational for evaluation in prediction of patients with sepsis in Emergency Department.