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.

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 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 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 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 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 determine a combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department (ED).Methods A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013.Eight biomarkers were determined,including levels of procalcitonin (PCT),interleukin-6 (IL-6),D-dimer,C-reactive protein (CRP),brain natriuretic peptide (BNP),white blood cell count (WBC),percentage of immature neutrophil,and platelet count (PLT).Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis.Then all these patients were stratified into severe sepsis group (190 cases,including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis.Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis,and the optimal combination of biomarkers was established.Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.Results PCT,IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis.The area under the ROC curve (AUC) of the combination of three biomarkers was 0.866 for diagnosis of sepsis,and it was higher than the AUC of PCT (0.803),IL-6 (0.770) and D-dimer (0.737) alone,and this new combination showed better sensitivity,specificity,positive predictive (PPV),and negative predictive (NPV) values than that when the three biomarkers was used individually (the results of combination were 81.2％,8 1.0％,90.6％,56.5％ ; that of PCT were 75.2％,80.0％,89.5％,58.8％; that ofIL-6 were 81.0％,61.0％,82.4％,58.7％; and that of D-dimer were 79.9％,59.0％,81.5％,56.5％,respectively).The AUC of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone,which was 0.758 for PCT,0.740 for IL-6,and 0.704 for D-dimer respectively.Moreover,the sensitivity,specificity,PPV and NPV of the combination were higher than that of the three biomarkers used singularly (the results of combination were 81.6％,73.6％,56.0％,90.6％; that of PCT were 79.5％,65.0％,48.2％,88.5％; that of IL-6 were 65.8％,70.6％,47.9％,83.4％; and that of D-dimer were 60.5％,73.2％,48.1％,81.8％,respectively).Conclusion The combination of PCT,IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.

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 effects of different cardiopulmonary resuscitation (CPR) qualifies under Q-CPR control on hemodynamics and aerobic metabolism in pigs with cardiac arrest. Method After eighteen pigs (mass [ (30+ 1) kg] were anesthetized,a Swan-Ganz catheter was positioned through the right femoral vein and linked with a continuous cardiac output monitor. An electrode cable was positioned into right ventricle through left internal jugular vein. Then different catheters were positioned in the arteriae aorta, carotid artery and fight atrium successively. Ventricular fibrillation (VF) was induced by a programmed electrical stimulation equipment. All animals underwent 4 minutes of untreated VF and then were randomly assigned to either standard CPR or nonstandard CPR. A Philips HeartStart MRx Monitor/Defibrillator was used to ensure qualifies of chest compression (e.g., depth, rate and chest recovery) by Q-CPR technology. Pigs in standard CPR group were treated with standard compression with a compression rate of 100 beat/min, a compression-ventilation ratio of 30:2, and a depth of with 38～51 mm with 100% decompression. Pigs in nonstmdard CPR group were treated with nonstandard compression with a depth of 60%～70% of standard depth with unsatisfactory decompression. Defibrillations were administered after 9 minutes of compressions and vetilations. Cardiac output (CO), mean aortic pressure (MAP) and coronary perfusion pressure (CPP) were recorded at different periods. Oxygen delivery (DO2) and oxygen consumption (VO2) were calculated according to blood gas analysis. At last,number of the survivals was recorded.Data were calculated by SPSS 11.5 statistics software. Statistical analysis was performed using Chi-Square Test and two independent samples t testing. Results The return of spontaneous circulation (ROSC) achievement ratio with nonstandard CPR was 28.6% and with standard CPR was significantly greater (90.9%, P=0.013).Hemodynamics (e. g., CPP, CO and MAP) and systemic oxygenation with standard CPR were much better. Conclusions In this animal model of cardiac arresr in pigs, standard CPR could improve hemodynarmics by increasing CPP and CO. And standard CPR could beneficial aerobic metabolism by increasing DO2 and VO2. As a result, ROSC achievement ratio of pigs with standard CPR was much greater.

Objective To establish a stabile normal model of cardiac arrest (CA) by programmed electrical stimulation(PES). Method Eighteen healthy domestic swine were anesthesiased with propofol. Ventrieular fibril-lation (VF) was induced by PES through right ventricle after tracheal intubation. The PES mode is S1S2 (300/200 ms), 40 V, and-10 ms step length. Results VF was successfully induced in 16 of eighteen swine with the method of PES. The extent of coupling interval of S1S2 was between 110 and 190 ms (168±23) ms. VF occurred in 2 swines when S1S1 (350 ms) stimulus was used to decide if the electrede was placed in right ventricle. All the swine were successfully defibrillated after 3 minutes of untreated VF. Conclusions This swine model of VF is easy to repeat and orerase, and has little injury on the heart. Therefore PES is a good method to make animal car-diac arrest model.