Objective To investigate the change of levels of activated Nuclear Factor ?B (NF ?B) in the blood of patients with acute coronary syndrome (ACS) and its significance Methods Seventy six patients were divided into four groups: control group,stable angina pectoris group (SAP), unstable angina pectoris group (UAP), and acute myocardial infarction group (AMI) NF ?B was measured with ELISA Results The level of activated NF ?B was (0 61?0 35) ?g in control group and (0 59?0 39) ?g in SAP group, and (1 12?0 10) ?g, (1 41?0 18) ?g, (1 18?0 13) ?g, (0 82?0 18) ?g in UAP group and (1 28?0 14) ?g, (1 69?0 41) ?g, (1 55?0 45) ?g, (0 89?0 06) ?g in AMI group at 0～12 h, 12～24 h, 24～48 h, and 1 w time intervals respectively The levels of activated NF ?B were higher in UAP and AMI groups than that in control group or SAP group ( P

Objective To study risk factors associated with predisposition to Lm -ABM in adult patients and to evaluate the clinical features,management and out in this cohort of patients because Listeria monocytogenes (Lm) is the third most common cause of acute community acquired bacterial meningitis (Ac-ABM),after Streptococcus pneumoniae and Neisseria meningitides aetiologies.Methods A descriptive,prospective study carried out in a tertiary grade medical center emergency department in Beijing over a 10 -year period.During the study period,15 patients of Lm- ABM were included.Comparison of episodes of Lm - ABM versus other aetiologies was made.Results Fifteen episodes of Lm - ABM were identified in327 adult Ac - ABM patients.Three cohorts of individuals were vulnerable to Lm - ABM:the elderly ( RR=3.14; 95％ CI 1.84-5.35),the immunocompromised (RR =3.34; 95％ CI2.08-5.38),and pregnant women ( RR 12.48 ; 95％ CI 3.29 ～ 47.39 ).The classic triad of fever,neck stiffness,and altered mental status was present in 40％ (6 of 15) Lm - ABM patients.Similarly,40％ patients had at least one of cerebrospinal fluid (CSF) samples with features met the criteria of typical bacterial meningitis.The coverage of empirical antimicrobial therapy was microbiologically inadequate for 13 ( 86.7％ ) patients.The mortality rate was 33.3％ (5 of 15),and 7 (46.7％ ) of 15 patients led to an unfavorable outcome ( GOS ＜ 4),both of which were significantly higher than those in other aetiologies of Ac - ABM ( P =0.015P =0.009 respectively). Conclusions Our study showed the elderly,the immunocompromised patients,and pregnant women predisposed to Ac - ABM most likely to be Listeria monocytogenes aetiology.In contrast with similar previous reports, the current study showed that patients with meningitis due to Listeria monocytogenes did not present with atypical clinical features.A high proportion of patients received empirical antimicrobial therapy that did not cover Listeria monocytogenes.Lm - ABM is still a serious disease that leads to high morbidity and mortality rates.With these important caveats in mind,our findings have implications for clinical practice and food safety policy makers.

Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes (ICG R15), effective hepatic blood flow (EHBF) and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group (n = 110) and hepatic failure group (n =18). ICG R15, EHBF, Child's score, histology activity index (HAI) score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child's score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure (t = 11. 121,2. 356, 3. 915, P ＜ 0.05). EHBF of patients without hepatic failure was (1.2 ±0.2) L/min, which was significantly higher than (1.0 ±0.2) L/min of patients with hepatic failure (t = 2. 802, P ＜ 0. 05). In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF ＜ 1.0 L/min were risk factors of postoperative hepatic failure (x2 = 4. 758, 9.709, 5. 362, P ＜ 0.05).ICG R15 was negatively correlated with EHBF (r =-0. 527, P ＜0.05). HAI score was positively correlated with ICG R15 (r =0. 638, P ＜0.05), while it was negatively correlated with EHBF (r =-0. 445, P ＜0. 05).Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF ＜ 1.0 L/min are prone to have postoperative hepatic failure.

Objective: To investigate the relationship between serum levels of high sensitivity cardiac troponin T (hs-cTnT) and the severity of coronary lesions in patients with stable coronary artery disease (SCAD). Methods: A total of 450 SCAD patients with coronary angiography (CAG) conifrmed diagnosis in our hospital were studied, and serum levels of hs-cTnT were examined at 3 days prior CAG in all patients. Based on tertiles of Gensini score, the patients were divided into 3 groups: Low score group,n=153 patients with Gensini score<14, Intermediate score group, n=145 patients with Gensini score at 14-28 and High score group,n=152 patients with Gensini score>28. The relationships between Gensini score and hs-cTnT levels were analyzed among 3 groups. The optimal cut-off value of hs-cTnT for predicting high Gensini score and the need of revascularization were studied by ROC curve, the relationships between hs-cTnT and high Gensini score, the need of revascularization were further detected by Logistic regression analysis. Results: The median values (25%-75%) of hs-cTnT in Low score group, Intermediate score group and High score group were 6.72 (4.20, 8.93) pg/ml, 7.90 (5.74, 12.68) pg/ml and 14.99 (10.26, 24.30) pg/ml respectively, allP<0.01. ROC curve analysis indicated that the area under curve (AUC) of hs-cTnT for predicting high Gensini score was 0.837 (95% CI 0.803-0.874), for the need of revascularization was 0.772 (95% CI 0.728-0.817); the best cut-off value of hs-TnT for predicting high Gensini score was 10.04 pg/ml and for the need of revascularization was 8.56 pg/ml. Logistic regression analysis suggested that with adjusted age, gender, the history of hypertension, diabetes, smoking, blood levels of creatinine, LDL-C and hs-CRP, hs-cTnT was still an independent predictor for high Gensini score (OR=1.13, 95% CI 1.06-1.20,P<0.001) and for the need of revascularization (OR=1.19, 95% CI 1.14-1.24,P<0.001). Conclusion: Serum level of hs-cTnT has been related to severity of coronary lesions in SCAD patients, hs-cTnT might be used as one of the pre-operative predictor for severe coronary disease and for the need of revascularization.

Objective To investigate the relationship between hyperhomocysteinaemia and unstable angina pectoris (UAP). Methods Selected 159 patients with senile hypertension combined with angina pectoris from April 2013 to April 2014, 78 cases of hyperhomocysteinaemia patients as observation group, 81 cases of simple hypertension patients as control group. All of the patients were performed coronary angiography examination, using the Gensini score method calculated the integral of the coronary lesions (CAS). Detected the level of the serum homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP), fasting blood glucose (FBG) and blood lipid levels. Results The gender, age, the levels of FBG and lipid in two groups had no significant differences ( P>0.05). The incidence of UAP,CAS and hs-CRP in observation group were 44.9%(35/78), (44.34±10.67) scores,(4.31±1.01)μg/L, in control group were14.8%(12/81), (30.24±8.76) scores, (2.13±0.95)μg/L. The incidence of UAP, CAS and hs-CRP in observation group were significantly higher than those in control group ( P<0.05). The levels of serum Hcy,TC,TG,LDL-C, hs-CRP, HDL-C in UAP patients of observation group and control group were (23.21 ± 7.35) and (8.86 ±2.43) μmol/L, (6.54 ±0.75) and (6.67 ±0.82) mmol/L, (1.84 ±0.95) and (1.62 ±0.83) mmol/L, (4.65±0.78) and (4.42±0.72)mmol/L,(5.15±1.24) and(3.21±1.15) mg/L, (1.02±0.32) and(1.01±0.35) mmol/L. The levels of serum Hcy,TC,TG,LDL-C, hs-CRP, HDL-C in SAP patients of observation group and control group were (12.54±4.37) and (6.52±1.36)μmol/L, (4.23±0.54) and (4.43±0.57) mmol/L, (1.45 ±0.76) and (1.25 ±0.68) mmol/L, (2.67 ±0.45) and (2.43 ±0.43) mmol/L, (3.02 ±1.13) and (1.52±0.98) mg/L, (1.24±0.36) and (1.26±0.34) mmol/L.There were significant differences (P<0.05). Multi-factor Logistic regression analysis showed that the senile H-type hypertension was independent risk factor of UAP (OR=4.324, 95%CI 2.463-6.874, P=0.001). Conclusions The levels of serum Hcy is closely related to the stability of the coronary artery atheromatous plaque and lesion severity of coronary artery. The senile H-type hypertension is independent risk factor of UAP.

Objective To investigate the epidemiology and features of severe poisoning.Methods A retrospective analysis of patients with severe poisoning admitted into the emergency intensive care unit of Peking Union Medical College Hospital from February 2008 to March 2010 was made.Results A total of 138 patients consisting of 45 males and 93 females were enrolled.The average age was 39.2 years.Committed suicide with toxic agents was the major cause of poisoning (76.8％ ),followed by alcoholism (8.7％ ) and misuse of medicine (5.8％).Of them,96.4％ patients were poisoned by swallowing poison agents,and 45.7％ patients were treated with gastric lavage and 15.2％ of patients with hemofiltration.Mortality was 3.62％.Conclusions Our study presents the current status of acute severe poisoning in the large general hospital.

Objective To evaluate the effectiveness and safety of percutaneous transhepatic balloon dilation for the removal of common bile duct stones.Methods 60 patients of common bile duct stone were divided into two groups:PTBD group (30 cases) and endoscopic sphicterotomy (EST) group (30 cases).Postoperatively biliary tract was drained for three days.Results All stones were removed in 28 patients (93％) in PTBD group and 29 cases (97％) in EST group.Early complications occurred in 13％ in PTBD patients and in 17％ in EST patients(x2 =0.35,x2 =0.13,P ＞0.05).There was no mortality in neither group.Long-term complications such as gallstone recurrence and cholangitis in PTBD group was significantly less than that in EST group (x2 =6.41,P ＜ 0.05).Conclusions The success rate of PTBD was similar to that of EST and while in PTBD the function of Oddi's sphincter was well reserved.PTBD procedure is a valuable alternative to EST in patients with bile duct stones,especially in patients who are not suitable for EST.

ObjectiveTo evaluate radio-frequency hemostasis in hepatectomy.MethodsFrom January 2009 to February 2011,the clinical data of 60 patients undergoing curative liver resection were divided into two groups using radio-frequency hemostasis (RFH) and clamp crushing method (CCM) respectively,RFH group (30 cases) and CCM group (30 cases).There was no difference between the 2 groups regarding the age,sex.hepatic function and tumor size.Data regarding the intra-operative and postoperative courses of the patients were analyzed.ResultsNo damage of hepatic vein occured in RFH group.Hepatic veins rupture occurred in 5 cases and massive bleeding occurred in 3 cases in CCM group.lntra-operative blood loss was significantly less in FRH group [ (219 ±62) ml] than in CCM group [ (416 ±96) ml ] (P ＜ 0.05 ).The postoperative drainage volume in RFH group was significantly less than that in CCM group on the third postoperative day.The serum ALT and T-BIL in RFH group was significantly lower than that in CCM group on postoperative day 1 and day 7 ( separately t =5.987,16.803,22.264,8.386,8.255,all P ＜0.05 ).Postoperative hepatic function in RFH group was significantly better than that in CCM group.ConclusionsThe use of radio-frequency hemostasis in hepatectomy is less traumatic,of less bleeding,faster recovery than clamp crashing method.

Objective:To analyze the changes of mean arterial pressure (MAP) and end expiratory carbon dioxide (ETCO 2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO 2 monitoring in early prediction of severe cardiovascular collapse (CVC) after emergency ETI. Methods:The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital. The values of MAP and ETCO 2 were observed and recorded at 5, 10, 30, 60 and 120 min after intubation. According to whether severe CVC occurred after ETI, the patients were divided into the severe CVC group and non-severe CVC group. The values of MAP and ETCO 2 were compared at the same time points between the two groups and the adjacent time points within the groups. The correlation between MAP and ETCO 2 after ETI was also analyzed. ROC curve was used to analyze the ability of MAP and ETCO 2 at 5 min and 10 min after ETI to predict severe CVC. Results:Totally 116 patients were enrolled in this study, among them 75 (64.7%) cases had severe CVC after ETI. The majority were male and elderly patients in the severe CVC group. The values of MAP and ETCO 2 in 5, 10, 30, 60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group. The values of MAP and ETCO 2 in the two groups showed simultaneous decrease from 5 min to 30 min after ETI, reached the lowest value at 30 min after ETI, and appeared the synchronous recover from then to 120 min after ETI. After ETI, the changes of MAP was correlated with that of ETCO 2 ( rs = 0.653, P<0.01). At 5 min after ETI, MAP could predict severe CVC (AUC=0.86, P<0.01), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%); ETCO 2 could also predict severe CVC (AUC=0.85, P<0.01), and ETCO 2≤35 mmHg was the best cutoff value (sensitivity 77.3%, specificity 85.4%). At 10 min after ETI, MAP could predict severe CVC (AUC = 0.90, P<0.01), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), ETCO 2 could also predict severe CVC (AUC=0.87, P<0.01), and ETCO 2≤33 mmHg was the best cutoff value (sensitivity 81.3%, specificity 78.0%). There was no significant difference in the ability of prediction between any two indexes of the MAP and ETCO 2 at 5 min and 10 min after ETI ( P>0.05). Conclusions:Patients with severe CVC after ETI have early signs of decreased MAP and ETCO 2, but the delayed recognition and insufficient intervention may be related to the occurrence and development of severe CVC. MAP and ETCO 2 at the early stage after ETI have high accuracy in predicting severe CVC. MAP≤72 mmHg, ETCO 2≤35 mmHg at 5 min after intubation, MAP≤67 mmHg and ETCO 2≤33 mmHg at 10 minutes after intubation all suggest the possibility of severe CVC.

Objective: To analyze the epidemiological characteristics of adult inpatients with gas burns in the Department of Burns of Hwa Mei Hospital of University of Chinese Academy of Sciences (hereinafter referred to as the author′s unit) , so as to provide evidence for the prevention of gas burn. Methods: Medical records of all inpatients with flame burns admitted to the author′s unit from January 2011 to December 2017 were collected. The percentage of adult inpatients with gas burns in total inpatients with flame burns in the same period, and their gender, age, injury season, accident place, burn severity, common compound injury, complication, population caliber, education, industry, as well as the pre-injury disease and prognosis of elderly inpatients with gas burns were retrospectively analyzed. In addition, the age, accident place, education, and industry of the floating population in the adult inpatients with gas burns were analyzed separately and compared with the total population of adult inpatients with gas burns in 7 years. Data were processed with chi-square test or Fisher′s exact probability test (Monte Carlo algorithm). Results: During the 7 years, 1 490 inpatients with flame burns were admitted to the author′s unit, among which 511 were adult inpatients with gas burns, accounting for 34.30%. The number of adult inpatients with gas burns increased gradually during the 7 years, but its percentage in the total inpatients with flame burns during the same period showed no significant difference (χ²=7.087, P>0.05). Among the 511 adult inpatients with gas burns (hereinafter referred to as the patients in this group), there were 315 males and 196 females, with a male/female ratio of 1.61 to 1.00, and the middle-aged patients were the most, up to 270 cases, accounting for 52.84%. The distribution of adult inpatients with gas burns during the 7 years was significantly different in gender and age (χ²=54.810, 27.832, P<0.01). Among the patients in this group, most were injured in summer, totally 251 cases, accounting for 49.12%, and the accident place was mainly at home, totally 388 cases, accounting for 75.93%. The distribution of adult inpatients with gas burns during the 7 years was significantly different in injury season (χ²=42.254, P<0.01), but not in accident place (χ²=6.782, P>0.05). The patients in this group were mainly with moderate burns (237 cases, accounting for 46.38%), and the distribution trend of burn severity of adult inpatients with gas burns was basically the same during the 7 years (χ²=19.680, P>0.05); 176 patients (34.44%) were accompanied by inhalation injury, and 30 patients (5.87%) were accompanied by blast injury of lung; post injury complications occurred in 20 patients (3.91%). In the elderly inpatients with gas burns, 44.44% (32/72) were accompanied by pre-injury basic diseases, and the proportion of death or unhealed reached 18.06% (13/72). Most of the patients in this group were permanent residents (358 cases, accounting for 70.06%) and received secondary education (304 cases, accounting for 59.49%), and the majority of them were engaged in manufacturing/construction (138 cases, accounting for 27.01%), self-employed business (90 cases, accounting for 17.61%), and catering (90 cases, accounting for 17.61%) industries. The distribution of adult inpatients with gas burns during the 7 years was significantly different in population caliber, education, and occupation (χ²=17.496, 29.898, 88.896, P<0.05 or P<0.01). Among the patients of this group, the floating population were mainly young (90 cases, accounting for 58.82%) and middle-aged (62 cases, accounting for 40.52%), with main accident place at home (97 cases, accounting for 63.40%), generally received secondary education (101 cases, accounting for 66.01%), and were mainly engaged in manufacturing/construction (71 cases, accounting for 46.41%), self-employed business (26 cases, accounting for 16.99%), and catering (20 cases, accounting for 13.07%) industries. Compared with the total adult inpatients with gas burns in 7 years, the floating population were younger, more injured in the workplace, and more concentrated in industry (χ²=42.924, 9.390, 27.819, P<0.01). Conclusions Gas burn was the leading injury cause of inpatients with flame burns in the author′s unit, which mainly occurred in summer and at home; the patients were mainly male, young and middle-aged, and permanent residents, most of which were with moderate burn, often accompanied by inhalation injury. Most of the patients were of secondary education, engaged in manufacturing/construction, self-employed business, and catering industries, among which the floating population were younger, more injured in the workplace, and more concentrated in industry. In order to prevent gas burn, we should pay more attention to the propaganda and education of gas safety among young and middle-aged men, floating population, retired old people and housewives, especially in summer, we should do a good job in gas safety inspection at home. In addition, we should urge enterprises to further strengthen the supervision of production safety.