Objective To investigate the change in blood lymphocyte levels and lymphocyte percentage in critical patients,including those with non-infectious systemic inflammatory response syndrome (SIRS),sepsis and severe sepsis.Methods Clinical data of 423 patients admitted to intensive care unit (ICU) of Department of Emergency of Peking University Third Hospital from January 2011 to September 2013 were retrospectively analyzed.Among these patients,there were 54 with non-infectious SIRS,177 with sepsis and 192 with severe sepsis.150 of them died,and 273 survived.The white blood count (WBC),neutrophil (N),lymphocyte count,lymphocyte percentage,lactic acid,serum high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) were determined at admission,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was estimated.The patients were divided into different groups according to diagnosis and prognosis to compare the value of the indexes,and the correlation between lymphocyte count and other markers were analyzed by Spearman relative analysis.Results The older the patients,the more severe the disease.In the non-infective SIRS,sepsis and severe sepsis groups,APACHE Ⅱ scores (7.78 ± 3.72,13.85 ± 7.22,24.00 ± 9.79),time of stay in hospital [days:6.0 (1.0,9.0),12.0 (8.0,22.0),19.5 (7.0,29.0)],the mortality rate (0,10.2％,52.6％),WBC (× 109/L:7.59 ± 3.27,8.94 ± 3.95,10.32 ± 5.50),N (0.685 ± 0.132,0.778 ± 0.135,0.831 ±0.086),hs-CRP [mg/L:4.60 (2.80,7.52),23.58 (13.49,49.22),59.77 (19.36,110.62)] andPCT [μg/L:0.05 (0.05,0.05),0.09 (0.05,0.61),0.63 (0.10,5.25)] showed gradually increasing tendency (all P=0.000).Serum lymphocyte count levels [× 109/L:1.53 (0.89,1.88),0.90 (0.65,1.42) and 0.80 (0.50,1.12)],lymphocyte percentage (0.225 ± 0.122,0.138 ± 0.097,0.106 ± 0.070) showed gradually decreasing tendency (P＜0.05 or P＜0.01).There was significant difference in blood lactic acid among three groups [blood lactic acid were 2.40 (1.30,5.10),1.10 (0.80,2.00) and 1.40 (1.00,2.50) mmol/L in the non-infective SIRS,sepsis and severe sepsis groups respectively,P=0.000].Age (years old:76.71 ± 12.21 vs.73.21 ± 14.49),APACHE Ⅱ score (24.69 ± 9.58 vs.13.91 ± 8.41),time of stay in hospital [days:12.0 (4.0,28.0) vs.11.0 (8.0,22.0)],WBC (× 109/L:10.29 ± 5.82 vs.8.89 ± 3.98),N (0.809 ± 0.130 vs.0.776 ± 0.120),lactic acid [mmol/L:1.80 (1.10,2.90) vs.1.30 (0.90,2.49)],hs-CRP [mg/L:50.94 (19.21,97.13) vs.21.71 (6.39,54.40)] and PCT [μg/L:0.74 (0.13,5.83) vs.0.08 (0.05,0.59)] levels in the death group were higher than those in the survival group (P＜0.05 or P＜0.01),serum lymphocyte count levels [× 109/L:0.90 (0.50,1.29) vs.1.05 (0.70,1.54)],lymphocyte percentage (0.123 ± 0.098 vs.0.143 ± 0.097) level in the death group were obviously lower than those in the survival group (P＜0.01 and P＜0.05).Serum lymphocyte count levels were negative correlated with N (r=-0.597,P=0.000),hs-CRP (r=-0.298,P=0.000),PCT (r=-0.304,P=0.000),APACHE Ⅱ (r=-0.124,P=0.000),and positively correlated with lymphocyte percentage (r=0.691,P=0.000),and non correlations was found with WBC (r=0.082,P=0.091) and lactic acid (r=0.073,P=0.132).Conclusion The serum lymphocyte levels in the critically ill patients are related with the severity of sepsis,and monitoring the change in lymphocyte may be an indicator for evaluating the illness and effect of treatment.

Objective To discuss the problem of upper respiratory tract infection presenting various clinical manifestations in adults thereby likely making misdiagnosis and to put forth the patients with the symptom of acute abdominal pain as examples in order to caution emergency physicians to avoid misdiagnosis and mistreatment.Methods Data of 58 adult patients with upper respiratory tract infection were collected from January 2010 to December 2011.The chief complain of these patients was acute abdominal pain.After analysis of data including clinical history,symptoms and signs,laboratory findings and medication,patients were divided into two groups post hoc:correctly diagnosed group (group A) and misdiagnosed group (group B).In group A,anti-chill medicine such as tylenol cold tablets (a compositus of paracetamol,pseudoephedrine hydrochloride,dextromethorphan and chlorpheniramine) was given to patients,while in group B,anisodamine (muscarine cholinergic blocker) and antibiotics were given instead of anti-chill medicine.The anti-chill medicine such as tylenol cold tablets would be given to patients of group B when abdominal pain was not released 8-48 hours after treatment.The course of treatment and outcome of patients in the two groups were observed.Results Of 28 patients in group A,27 had abdominal pain relieved or disappeared 2-3 hours after treatment and only 1 patient had abdominal pain lasted 12 hours after treatment.Of 30 patients in the group B,only 2 patients presenting the symptom of acute gastroenteritis got totally relived 2-3 hours after treatment,while the rest of 28 patients did not get rid of abdominal pain,or only had brief period of painlessness after anisodamine injection.Alternatively,8-48 hours later as Tylenol Cold Tablets was given to patients of group B,the abdominal pain was relieved or disappeared after 2-3 hours without recurrence in 2-48 hours.Conclusions Upper respiratory tract infection manifests diversely in adults,and acute abdominal pain could be a main clinical manifestation.Anti-chill medicine,such as tylenol cold tablets,has a noticeably therapeutic effect for acute abdominal pain caused by upper respiratory tract infection in adults,while anisodamine injection makes poor efficacy.

ObjectiveTo observe the effects of electroacupuncture on IL-1β in brain tissue of rats after total cerebral ischemia-reperfusion.MethodsThirty male Wistar rats were randomly divided into the sham operation group, model group and acupuncture group, in each group. In acupuncture group and model group, 4-vessel-occlusion method was used to make a rat model of cerebral ischemia reperfusion. Acupuncture group used electroacupuncture on points Quchi and Zusanli, 6 hours after reperfusion. The rats of each group were killed and ELISA was used for the measurement of IL-1β in brain tissues.ResultsIL-1β in brain tissue in model group increased significantly compared with sham operation group and acupuncture group(P<0-001). No significant differences were found between sham operation group and acupuncture group (P>0-05).ConclusionAcupuncture can lower IL-1β content of brain tissue of rats with brain ischemia/reperfusion injury.

Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction(LVDD) in septic shock patients.Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group.General clinical data,APACHE scores,NT-proBNP,Troponin I(TNI),creatinine,procalcitonin,D-dimer and lactic acid within the first 24 hours after admission were recorded,and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value.Results There were no significant differences in general clinical data,procalcitonin,D-dimer and lactic acid between two groups.Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP (3.66±0.38) vs.(3.03±0.59),P =0.000],TNI [lgTNI(-1.45±0.86)vs.(-2.36±0.82),P ＜ 0.01] and creatinine [(186.12±124.24)vs.(101.16±57.01),P ＜ 0.01] in LVDD group were significantly higher.It was shown by multi-factors logistic regression analysis that NT-proBNP (OR=8.731,95％CI;1.541-49.466,P=0.014) was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients.The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL,sensibility =88.6％,specificity =62.1％.Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.

Objective To analyze clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with sepsis.Methods According to retrospective analysis of clinical data 136 cases with sepsis were divided into PH group and non-PH group.The clinical data,laboratory findings and ultrasonic cardiographic findings were recorded and compared between two groups.Multi-factors Logistic regression analysis was performed to find the independent risk factors of PH in patients with sepsis,and receiver operating characteristic curve ROC was constructed to indicate the predictable value.Results Of 136 patients with sepsis,32 (23.5％) developed PH.The PH group had higher NT-proBNP [lgNT-proBNP (3.67±0.41) vs.(3.33±0.59),P=0.003],higher E peak [(86.12±30.43) vs.(67.73±21.49),P=0.008],higher E/A peak [(1.09±0.46) vs.(0.83±0.29),P=0.014],higher left atrium diameter (LAD) [(36.49±5.97) vs.(31.32±4.69),P=0.001] and lower oxygenation index [(291.90±51.62) vs.(326.40±88.16),P=0.017] than the non-PH group (P ＜ 0.05).It was shown by multi-factors Logistic regression analysis that LAD (OR=1.198,P=0.010) was an independent risk factor of PH in patients with sepsis.The area under the curve AUC of LAD was 0.723,with the cut-off value of 31 mm (sensibility 82.6％,specificity 49.0％).Conclusions LAD was an independent risk factor of sepsis-associated pulmonary hypertension in sepsis patients.

Hyperparathyroidism is a common endocrine disease that seriously affects human health, depending on its etiology, which can be divided into three types: primary, secondary and tertiary. In clinical practice, we found that some primary hyperparathyroidism may be secondary or tertiary hyperparathyroidism caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, and become a common type of hyperparathyroidism. The daily calcium intake of Chinese people is generally insufficient. Vitamin D can promote the absorption of calcium, but vitamin D deficiency/insufficiency is also a worldwide public health problem. Long-term hypocalcemia will stimulate parathyroid hyperplasia and secrete excessive parathyroid hormone, resulting in parathyroid hyperfunction (pre-hyperparathyroidism) and then secondary hyperparathyroidism, both of which may damage bone and release calcium into blood, leading to diseases of multiple organs and tissues. The detection of bone metabolism indexes such as calcium, magnesium, phosphorus, parathyroid hormone and vitamin D may be helpful for the early diagnosis of pre-hyperparathyroidism and hyperparathyroidism. Supplementation of calcium and vitamin D in early stage can control the development of the disease and change "unpreventable and uncontrollable" into "preventable and controllable" . The health screening of bone metabolism indexes and parathyroid ultrasonography should be advocated, and the prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism should be strengthened, so as to greatly improve the bone health, urinary calculus, metastatic vascular calcification and systemic abnormal calcium migration and precipitation in the population.

Differentiated thyroid cancer is one of the most common endocrine malignant tumors, and thyroidectomy is its basic treatment measures. Insufficient attention is paid to its postoperative bone hungry syndrome and parathyroid hyperfunction or hyperparathyroidism, which will seriously affect the patient’s life quality and prognosis. This paper will explore the etiology, dangers, diagnosis, prevention, and treatment for hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy.

Objective:To analyze the predictive value of serological measures within 24 hours of admission in acute pancreatitis patients against patients with severe acute pancreatitis(SAP), because the severity of acute pancreatitis was characterized by a timely assessment and prediction by emergency department physicians upon visit.Methods:A total of 119 acute pancreatitis patients admitted in Emergency Department in Beijing Jishuitan Hospital, Capital Medical University from January 2022 to December 2022 were retrospectively collected. According to the revised Atlanta classification, patients were characterized by mild acute pancreatitis group (77 cases), moderately severe acute pancreatitis group (27 cases), and SAP group (15 cases). Basic characteristics, early disease severity scores and early serological indexes of the three groups were compared, independent risk factors of serological indexes affecting the occurrence of SAP were analyzed, and receiver operator characteristic curve was drawn, evaluate the predictive value of related serological indexes for SAP.Results:There were no significant differences in the basic characteristics of the three groups including of gender, age, BMI, type of pancreatitis and complications ( P>0.05), but there were significant differences in early BISPA, Ranson, APACHEⅡ and Panc3 scores among the three groups ( P<0.05).Albumin-bilirubin score ( OR=3.653, 95% CI 1.665-8.012, P=0.001), blood urea nitrogen ( OR=1.117, 95% CI 1.039-1.202, P=0.003) were independent risk factors for SAP. The areas under ROC curve predicted by albumin-bilirubin score, blood urea nitrogen and albumin-bilirubin score combined with blood urea nitrogen were 0.762, 0.776 and 0.857, respectively, which showed no statistical difference compared with earlier Ranson, BISAP and APACHE Ⅱ scoring systems, respectively ( P>0.05). Conclusions:Early albumin-bilirubin score and blood urea nitrogen indexes of acute pancreatitis patients have good predictive value for SAP. Albumin-bilirubin score combined with blood urea nitrogen can improve the predictive value of SAP, and the predictive effect is as good as early Ranson, BISAP and APACHEⅡ scoring systems.

OBJECTIVEThe aim of this study was to investigate the impact of air pollution on the number of pediatric outpatient and emergency room visits in January 2013.

METHODSHealth-related data was from a major hospital in Haidian,Beijing while related data on air pollution was from the Chinese Research Academy of Environmental Sciences. Data on weather was from the China Weather Website. Number of hospital outpatient visits per day during the haze period was compared to those from the previous year to get the increase of percentage. Concentration-response functions were estimated using generalized additive modeling with natural log link function, while multiple structural change test was used to determine the changing point in CRFs. Constrained piecewise linear function was used to estimate the risks for different segments of CRFs.

RESULTSThe peak of NO(X), SO₂, PM(2.5) and PM(10) reached 672.63 µ g/m³, 146.20 µ g/m³, 312.19 µ g/m³ and 995.00 µ g/m³, around 28 December 2012 and 10 January 2013. The peaks of visits to the pediatric department were observed at the some days, showing 47.75% and 34.14% of increase in the visits to the pediatric department. In the low or intermediate ranges of concentration, all the four air pollutants were significantly associated with pediatric outpatient visits, in the form of C- and S- shape of concentration-response function. However, in the range of high concentration, only PM(10) and SO₂were significantly associated with the number of visits to the pediatric emergency room, appeared as the J-shape form. Discernable thresholds were found in S- and J- shapes which were located at 200 µg/m³, 20 µg/m³, 40 µg/m³ and 100 µ g/m³ for NO(X), SO₂, PM(2.5) and PM(10), respectively.

CONCLUSIONAir pollution during the haze period was associated with the increase of pediatric outpatient and emergency room visits. There were different sensitive groups within the pediatric cases. Their susceptibility showed a decreasing trend from C-, S-, to J- shape related group.

Air Pollution ; adverse effects ; Child ; China ; epidemiology ; Emergency Service, Hospital ; utilization ; Humans ; Outpatients ; Weather