Objective To evaluate the value of gelsolin for the prognosis of patients with severe sepsis.Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015,were determined white blood cell count (WBC),C-reactive protein (CRP),procalcitonin (PCT),gelsolin at admission,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were estimated within 24 hours.According to the 28 days of survival outcome,50 patients were divided into two groups:survival group and death group.The significant difference of these factors was compared.Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death.The receiver operating characteristic (ROC) curve was applied for the evaluation and comparison about prognosis ability.Results 31 patients were in the survival group,19 patients in the death group.The gelsolin [(21.43±10.54) vs.(13.31±8.54),P=0.007] andAPACHE Ⅱ score [(19.2±6.86) vs.(24.6 ± 8.9),P =0.021] in two groups had significance difference.Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death.The area under of ROC curve (AUC) of the gelsolin was 0.745 (95％ CI:0.599-0.851,P =0.004) and the APACHE Ⅱ score was 0.699 (95％ CI:0.537-0.862,P =0.019).Both prognosis ability were equivalent.To combine the tow factors,the accuracy of predition was 90％ and has better complementarity.Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.

Objective To investigate clinical value of gelsoin level for evaluating severity and prognosis in patients with critical illness. Methods Forty-eight patients with critical illness admitted to the Emergency Intensive Care Unit of Beijing Hospital during February to December 2008 were enrolled in this study, with 23 survivors and 25 deaths. Serum level of gelsolin was measured for 31 of them at least twice during their hospital stay, and for other 17 only once at their admission. They all were evaluated with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) scores within 24 hours after admission. In addition, serum level of gelsolin was measured for another 307 healthy adults as controls. Results Initial level of gelsolin was significantly lower in 48 patients at critically ill than that in controls [(24 ± 11) mg/L vs. (192 ±39) mg/L, P < 0. 01]. There was significant difference in initial level of gelsolin between surviving group (23 cases) and death group (25 cases) [(28 ± 10) mg/L vs. (21 ±12) mg/L, P = 0. 033]. Fatality of patients at critically ill increased as their level of gelsolin at 22 mg/L or less, with a predicting accuracy of 74. 19% , as well as decreasing trend of their gelsolin levels in continuously minitoring, with a predicting accuracy of 70. 97%. Predicting accuracy of APACHE Ⅱ scores of 30 or more was 67.74%. However, predicting accuracy would reach 93.55% as final level of gelsolin and its decreasing trend combined with APACHE Ⅱ scores in prognostic assessment for critically ill patients. Conclusions Severity of patients at critically ill can be predicted by their gelsolin level, especially in continuously monitoring, which is an indicator better than APACHE Ⅱ scores. Combination of gelsolin level with APACHE Ⅱ scores shows a more accurate prognostic assessment for critically ill patients.

Fast track surgery(FTS) is a novel surgery concept in recent years.Through using a series of perioperative optimization measures,to reduce the postoperative complications,the length of stay,and to achieve the goal of patients' rapidly rehabilitation.Nowadays,FTS protocols is widely used in general surgery,cardio-thoracic surgery,ophthalmology and orthopedics etc.This article reviewed the application of FTS in the perioperative patients which taking hip and knee arthroplasty.

500 ng/ml. Spiral-CT pulmonary arteriography(CTPA) was the main diagnostic method. Nineteen patients received thrombolytic therapy, Twenty-nine patients received anticoagulative therapy, 2 patients didn't receive any therapy because of bleeding. Five(10%) patients were cured, 43 (86%) patients got better, 2(4%) patients were dead. Conclusions The clinical manifestations of pulmonary embolism in the elderly were varied. CTPA is the main diagnostic method and ventilation-perfusion lung scan or pulmonary angiography can be done when it is necessary. Thrombolytic treatment can improve the survival rate of patients with acute pulmonary embolism.

Objective To discuss clinical results of the treatment of op en tibio-fibula fractures with the intramedullary interlocking nails. Methods A group of 46 cases of open tibio-fibula fractures was collected and classified according to Gustilo classification. There were 12 cases of type Ⅰ, 9 cases of type Ⅱ, 16 cases of typeⅢA, 7 cases of type ⅢB, and 2 case of type ⅢC. All o perations were performed in the emergency operation room and all patients were f ixed with intramedullary interlocking nails. Results The follow-up of 8 months to 3 years (with an average of 20 months) showed satisfactory results, though th e local wounds needed skin flap transplantation in 6 cases and muscle flap trans plantation was performed in 1 case. Conclusion Open tibio-fibula fractures of t ype Ⅰ, type Ⅱ and type ⅢA can be treated with emergency debridement and the intramedullary interlocking nails, if the injury duration is short and the vital signs of the patients are stable.

Objective To review the results of operative treatment of the distal radius fractures. Methods The group of 12 cases were classified accorded to universal classification. There was 1 case of type Ⅲ, 3 cases type ⅣA,2 cases type ⅣB, 5 cases type ⅣC and 1 case type ⅣD. Five of them were checked preoperatively by spiral CT and three dimensional evaluation. They were given respectively treatment by external fixation, by volar or dorsal buttress plate, with or without percutaneous K wires. Results The average period of follow up was 12 months. 9 cases were excellent and 2 cases were good. The excellent and good rate was 91.7%. Conclusions Operative interventions for intra articular fractures of distal aspect of the radius should be considered when non operation management failed. The spiral CT and three dimensional evaluation can reveal enough information about the fracture preoperatively. The proper operative method should be chosen according to the fracture type.

Objective:To investigate the relationship of etiology and complications of rhabdomyolysis with its prognosis in the elderly.Methods:Patients with rhabdomyolysis at the emergency department of our hospital from January 1, 2018 to December 31, 2019 were retrospectively analyzed.Based on age, patients were divided into the non-elderly group(<65 years old)and the elderly group(≥65 years old). The frequency distribution of etiological factors, concurrent acute kidney injury, and their association with prognosis were analyzed.Results:The number of patients with rhabdomyolysis caused by 2 or more etiologies was higher in the elderly group than in the non-elderly group(40.3% or 48/119 vs.17.0% or 16/94, χ2=13.582, P=0.000). The frequency distribution of etiological factors was different between the two groups.The top-five etiologies were infection, muscle ischemia/hypoxia, endocrine metabolic abnormalities, trauma and muscle fatigue in the elderly group and muscle fatigue, infection, endocrine metabolic abnormalities, drugs/toxicants and trauma in the non-elderly group.Compared with the non-elderly group, the elderly group had fewer patients with typical clinical manifestations(32.8% or 39/119 vs.48.9% or 46/94, χ2=5.067, P=0.024). In contrast, patients who newly presented with disturbance of consciousness were more likely to be found in the elderly group than in the non-elderly group(40.3% or 48/119 vs.21.3% or 20/94)( χ2=7.923, P=0.005). There were 37 patients with AKI(38.9% or 37/95)in the elderly group and 13 of them died(35.1%), and there were 17 patients with AKI in the non-elderly group(19.3% or 17/88)and 4 died(23.5%), indicating the elderly were prone to AKI( χ2=7.545, P=0.006). There was a significant correlation between AKI and prognosis in the non-elderly group( χ2=7.196, P=0.007). Conclusions:Rhabdomyolysis caused by multiple etiologies is more common in elderly patients than in non-elderly patients.The etiological classification of rhabdomyolysis in the elderly is different from that in the non-elderly.Elderly patients are less likely to have typical clinical manifestations and are more prone to AKI.Elderly patients with rhabdomyolysis combined with AKI have a poor prognosis.

Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.

Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST,presepsin) combined with national early warning score (NEWS) for predicting the prognosis of emergency patients with sepsis.Methods To select 119 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study.The serum samples were collected immediately as they came,the presepsin was measured,and the NEWS scorescalculated.Patients were divided into survival group (81 cases) and death group (38 cases) according to the 30-day prognosis,and the value of the presepsin,NEWS score and presepsin + NEWS score in the assessment of prognosis were compared.Results Presepsin and NEWS scores both were higher in the death group than the survival group.Presepsin and NEWS were the independent risk factors of the 30-day mortality of patients with sepsis.Under the ROC curve area (AUC) of presepsin and NEWS were 0.842 and 0.823;the combination of Presepsin and NEWS was 0.906.When presepsin ＞ 927.5 pg / mL and NEWS ＞ 6.5 points,it can significantly improve the efficacy of predicting prognosis.Conclusions Serum presepsin is a good indicator to judge the prognosis of patients with sepsis,and the combination with NEWS can improve the ability to predict the risk of septic death.

Objective In order to understand the mechanisms beyond lipid regulation of 3 hydroxy 3 methyl glutaryl coenzyme A(HMG CoA) reductase inhibitors in anti atherosclerosis, we observed the influence of pravastatin on the pathogenesis of atherosclerotic lesions and the expression of intercellular adhesion molecule (ICAM) 1 in aortic wall of the apoE deficient mice. Methods Pravastatin(10 mg?kg?d -1 ) was fed to 10 , 20 , and 30 week old male apoE deficient mice respectively for 4 weeks. The atherosclerotic plaque size and the ratio of plaque area to aortic luminal area (PA/LA) were determined by histochemical staining and analyzed quantitatively. The expression of ICAM 1 in aortic wall of apoE deficient mice was detected by immunohistochemistry and Western blotting. Results Compared with controls, pravastatin delayed the plaque formation in apoE deficient mice 〔(161 786 1?38 041 2) ?m 2 vs (99 127 9?13 600 3) ?m 2, P