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 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 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 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 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 compare therapeutic effect of single hemoperfusion and hemoperfusion combined with continuous veno-venous hemofiltration ( sequential continuous blood purification) on patients with severe acute organophosphate poisoning combined with myocardial injury.Methods A total of 80 patients with severe acute organophosphate poisoning combined with myocardial injury admitted to EICU of Beijing Chaoyang Hospital from Jan.2004 to Dec.2013 were respectively analyzed and divided into two groups: hemoperfusion group (patients collected from Jan.2004 to Dec.2008, n=41) and sequential continuous blood purification (patients collected from Jan.2009 to Dec.2013, n =39).The average cholinesterase recovery time, the average consciousness recovery time, the average doses of atropine, the average hospital time, the change of cardiac troponin I levels on days 1, 2, 3, 5 and 7 after admission, and the change of left ventricular ejection fraction within 24 h after admission and after 24 h following blood purification treatment were compared between the two groups.Results Patients in the sequential continuous blood purification group had less average cholinesterase recovery time, average consciousness recovery time, average doses of atropine and average hospital time compared with patients in the hemoperfusion group [ ( 87.6 ±8.8 ) h vs.( 113.8 ±13.3 ) h;(57.3 ±11.7) h vs.(100.5 ±10.8) h;(284.5 ±61.4) mg vs.(476.6 ±93.1) mg and (10.2 ±2.3) vs. (14.6 ±3.9) , all P<0.01].The levels of cardiac troponin I on days 2, 3, 5 and 7, and ejection fraction of left ventricule after 24 h following blood purification treatment in the sequential continuous blood purification group were significantly decreased compared with patients in the hemoperfusion group ( all P <0.05 ) . Conclusion Therapeutic effect of sequential continuous blood purification on patients with severe acute organophosphate poisoning combined with myocardial injury is superior to single hemoperfusion.It suggests that sequential continuous blood purification could be used as a preferred choice in treatment of patients with severe acute organophosphate poisoning combined with myocardial injury.

Pulmonary arterial hypertension (PAH) is an incurable fatal disease, with the mechanism of imbalance of vascular contraction and relaxation which start as a series of pathophysiological reactions. Angiotensin-converting enzyme 2-angiotensin (1-7)-G protein-coupled receptor axis [ACE2-Ang(1-7)-Mas], an expanded vascular axis which is considered as new axis of renin-angiotensin system (RAS) is a negative regulator of the classical angiotensin-converting enzyme-angiotensin Ⅱ-angiotensin Ⅱ type 1 receptor axis (ACE-AngⅡ-AT1R), a contraction vessel, proliferation axis. A retrospective study concerning the pathophysiological mechanism of ACE2 in the treatment of PAH was done and found that ACE2-Ang-(1-7)-Mas axis could reduce PAH induced by monocrotaline (MCT) through declining the inflammatory cascade, improving endothelial dysfunction and regulating autonomic nerve, reduce PAH induced by hypoxia through inhibiting the proliferation of pulmonary artery smooth muscle cells and reduce PAH induced by congenital heart disease. Therefore, ACE2 may become a future drug of preventing and treating PAH.

The cerebral resuscitation is the most important aim in advanced cardiopulmonary cerebral resuscitation (CPCR). Cerebral function protection after cardiac arrest (CA) is important to improve survival rates including those after the discharge. Therapeutic mild hypothermia maybe the only method that can improve neurological function of patients following resuscitation after CA, which was recommended as one of treatment strategies for unconscious patients after successful resuscitation in 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Although there are many cooling methods of inducing hypothermia, each has some advantages or shortcomings. There were many controversies on the choice, which need further research. We make a summary and analysis about the mechanism of therapeutic mild hypothermia, the possible complications at different stages and the clinical application of mild hypothermia, such as the evaluation before therapeutic mild hypothermia and the choice of hypothermia protocol and cooling methods, to provide guidance for clinical mild hypothermia therapy.

Objective To evaluate the effect of Shenfu injection(参附注射液) on hemodynamics and oxygen delivery(DO2) metabolism in dogs with cardiogenic shock.Methods A dog model of acute myocardial infarction was made by ligating the midpoint of left coronary artery.When the cardiogenic shock was found by the Swan-Gans vessel,18 dogs with cardiogenic shock were divided randomly into three groups: Shenfu,dopamine and control groups.The following drugs were intravenously administered: Shenfu injection 1 ml/kg to the Shenfu group,dopamine 10 ?g?kg-1?min-1 to the dopamine group and NaCl 5 ml/kg to the control group.Before the model was made and after the drugs were given for 30,60,90,120 and 180 minutes,the changes of the parameters of hemodynamics were monitored through the Swan-Gans vessel,inculding cardiac output(CO),pulmonary arterial wedge pressure(PAWP), pulmonary artery pressure(PAP),central venous pressure(CVP),heart rate(HR),blood pressure(BP) and angiosthenia(AP).Then the results of stroke volume(SV),stroke work(SW),mean arterial blood pressure(MAP),systemic vascular resistance(SVR) and pulmonary circulation resistance(PVR) were calculated by formulae.Arterial blood and mixed venous blood were used for blood gas analysis to measure and calculate the following hemodynamic parameters: DO2,oxygen consumption(VO2) and oxygen uptake rate(ERO2).The results were compared.Results ① In the control group,after NaCl was given,CO,SV,SW,HR and MAP were decreased gradually at the time points,while the PVR,PAWP and CVP were progressively increased at the same time(all P