Abstract Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient prognosis, often leading to multiple organ dysfunction syndrome (MODS), which is characterized by simultaneous dysfunction of two or more organ systems and significantly heightens the risk of mortality. Standard strategies for managing organ complications in critical illness may not always be suitable for patients with liver failure (LF).This study aims to investigate the outcomes of MODS in patients with ALF and ACLF in China, while also identifying factors influencing mortality and prognosis. We conducted a retrospective cohort study at a specialized tertiary hospital for liver diseases in Beijing, China, spanning from June 1, 2009, to May 31, 2022.Risk factors were assessed through univariate and multivariate analyses using logistic regression. Cumulative 90-day mortality rates between the ACLF and ALF groups were compared using Cox Analysis. 195 patients with ALF and 318 patients with ACLF were included in this study. The primary outcome of interest was 90-day mortality. This study enrolled a total of 513 patients. Of these, 119 patients (61%) with ALF and 140 patients (44%) with ACLF experienced MODS. Patients with ALF exhibited a higher number of organ failures compared to those with ACLF (2 vs. 1, P = 0.006). Additionally, patients with ALF demonstrated higher median admission critical illness scores.Multivariate logistic analysis indicated that GIB (OR = 3.112, 95% CI 1.4–6.916, P = 0.005), MELD-Na scores (OR = 1.079, 95% CI 1.033–1.127, P = 0.001), Age (OR = 1.056, 95% CI 1.025–1.088, P < 0.001), NLR (OR = 1.073, 95% CI 1.014–1.132, P = 0.014), ICU admission (OR = 4.319, 95% CI 1.347–13.851, P = 0.014), and Clif-SOFA (OR = 1.147, 95% CI 1.022–1.287, P = 0.02) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.881. Multivariate logistic analysis revealed that SOFA score (OR = 1.255, 95% CI 1.166–1.351, P = 0.001), GCS scores (OR = 0.674, 95% CI 0.606–0.881, P = 0.001), Age (OR = 1.048, 95% CI 1.022–1.076, P < 0.001), and ICU admission (OR = 0.258, 95% CI 0.075–0.885, P = 0.031) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.872.Cox analysis for cumulative 90-day mortality indicated that patients with ALF had higher mortality rates compared to those with ACLF (33.8% vs. 27%, P = 0.026) and compared to patients with cirrhosis ACLF and non-cirrhosis ACLF (33.8% vs. 31% vs. 25.9%, P = 0.018).Patients with ALF exhibited a higher incidence of MODS and consequently had a poorer 90-day prognosis.

Objective:To explore the clinical efficacy and safety of Nirmatrelvir/Ritonavir in retreatment for patients with recurrence of coronavirus disease 2019 (COVID-19).Methods:The COVID-19 patients hospitalized in Beijing Ditan Hospital, Capital Medical University and received Nirmatrelvir/Ritonavir therapy from April 17 to June 17 2022 were investigated and the clinical data were analyzed.Results:The retreatment with Nirmatrelvir/Ritonavir for the patients with recurrence of COVID-19 remained effective. The median value of time from the start of retreatment to negative conversion of nucleic acid was 8 (7-10) days. None of the patients showed adverse drug reaction.Conclusions:No drug-related adverse reaction was observed within the treatment course of Nirmatrelvir/Ritonavir and the therapy may be beneficial to shorten hospitalization and quarantine.

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241).

Objective:To investigate the clinical efficacy of high-flow nasal cannula (HFNC) oxygen therapy as the respiratory support for severe coronavirus disease 2019 (COVID-19) patients, and to analyze the risk factors of HFNC oxygen therapy failure in the treatment of severe COVID-19.Methods:A retrospective analysis was performed on the clinical data of patients who received HFNC oxygen therapy and met the criteria for severe COVID-19 in the Department of Intensive Care Medicine, Beijing Ditan Hospital, Capital Medical University from January 2020 to June 2020. Patients were divided into HFNC success group and HFNC failure group according to applying non-invasive/invasive positive pressure ventilation or not in the following treatment. T test or chi-square test were used to compare the differences between the two groups in basic data, APACHEII score, laboratory data, basic oxygenation index, time from onset to HFNC usage, baseline ROX index, and respiratory rate, oxygenation index and ROX index at 2, 4 and 12 hours after HFNC treatment. The risk factors of HFNC treatment failure were then analyzed.Results:A total of 40 patients were enrolled in the clinical study. Twenty-one patients (52.5%) successed in HFNC treatment and 19 patients (47.5%) failed. There were no significant differences between the success group and failure group in basic data, laboratory data, basal oxygenation index, time from onset to HFNC use, baseline ROX index, respiratory rate and oxygenation index at 2 h, 4 h and 12 h after HFNC treatment ( P>0.05). There were significant differences between the two groups in APACHEII score and ROX index at 2h, 4h and 12h after HFNC treatment ( P<0.05). Logistic regression analysis showed that APACHEII score and ROX index were independent risk factors for HFNC treatment failure. Conclusions:HFNC can be used as the respiratory support for severe COVID-19, and ROX index monitoring was a key factor in evaluating the success of HFNC treatment.

Objective To evaluate the value of Swansea diagnostic criteria in the diagnosis of patients with acute fatty liver of pregnancy (AFLP) in China. Methods The clinical data of patients discharged with AFLP in Beijing Ditan Hospital, Capital Medical University from January 1996 to March 2017 were retrospectively analyzed by using Swansea diagnostic criteria. The accuracy of Swansea diagnostic criteria for AFLP diagnosis, the major complications of maternal and fetus and the incidence of blood purification therapy at different score thresholds were evaluated. Results From January 1996 to March 2017, a total of 70 patients were diagnosed with AFLP. There were 65 cases (92.8%) whose Swansea diagnostic criteria score greater ≥6, the distribution was 3~13 and the average value was 8.6 ± 2.2. The major abnormal issues were elevated transaminase (69/70, 98.6%), elevated jaundice (67/70, 95.7%), elevated white blood cells (61/70, 87.1%), coagulation dysfunction (50/70, 71.4%), renal insufficiency (50/70, 71.4%), ascites or bright liver showed by ultrasonography (50/70, 71.4%) and renal insufficiency (50/70, 71.4%). The study found that with the score increased, the incidence of serious complications such as postpartum hemorrhage, liver failure, acute kidney injury, pulmonary infection and the need for blood purification support were gradually increased except premature delivery. Conclusion Swansea diagnostic criteria can diagnose AFLP accurately, the score can reflect the severity of the disease and the intensity of treatment intervention.

目的:人感染猕猴α疱疹病毒1型是罕见的人畜共患病，2021年4月，在中国北京一位实验动物饲养员出现发热、皮疹、行走无力等症状，后被诊断为人感染猕猴α疱疹病毒1型，病毒性脑脊髓炎，为我国首例人感染猕猴α疱疹病毒1型病患。这名患者在入院前出现心脏呼吸骤停，诊断为缺血缺氧性脑病并出现坏死性病毒性脑脊髓炎，住院期间脑功能损害逐渐加重，临床判定脑死亡，在患者入院39 d，病程第51 d，家属撤除治疗。

新型冠状病毒肺炎( COVID-19 )疫情在国内已经得到有效控制,但其他国家和地区仍呈增长态势[1].目前研究[2]显示,COVID-19 疫情的病原体新型冠状病毒主要损伤肺部,同时也可造成全身多脏器损伤,表现出广泛损伤的特点.急性胰腺炎( acute pancrea-titis,AP)是消化系统常见的危重疾病,发病率逐年升高,已成为严重危及我国人民健康和生命的重大疾病之一.尽管目前新型冠状病毒肺炎病例数量巨大,但目前仅有少量的报道[3]观察到合并急性胰腺炎.在COVID-19大流行中,首都医科大学附属北京地坛医院收治了北京市首例重症新型冠状病毒肺炎合并急性胰腺炎病例,经治疗后痊愈出院.为总结经验,提高救治水平,现将本例患者资料报道如下.

We reported that the complete genome sequence of SARS-Coronavirus-2 (SARS-CoV-2) was obtained from a cerebrospinal fluid (CSF) sample by ultrahigh-depth sequencing. Fourteen days after onset, seizures, maxillofacial convulsions, intractable hiccups and a significant increase in intracranial pressure developed in an adult coronavirus disease 2019 patient. The complete genome sequence of SARS-CoV-2 obtained from the cerebrospinal fluid indicates that SARS-CoV-2 can invade the central nervous system. In future, along with nervous system assessment, the pathogen genome detection and other indicators are needed for studying possible nervous system infection of SARS-CoV-2.

Background: The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. The mortality of patients diagnosed with acute respiratory distress syndrome (ARDS) ranges from 17.3 to 41.4% among critically ill patients with H1N1 infection. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. As is known to all, after the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. But very few articles describe the special circulation about the case who was post-operative of the modified Fontan operation especially when it received the treatment of E-CMO. This study aims to describe a successful case using E-CMO in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. We want to explore the special cardiac structure and circulatory characteristics in this case. Methods: To report a successful case using extracorporeal membrane oxygenation in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. In this article, we describe a 23-year-old man, with a history of modified Fontan operation for the Tausing-Bing syndrome, admitted to ICU with severe acute respiratory distress syndrome as a result of influenza A infection. The man was initially treated by V-V ECMO, five days later was switched to V-V-A E-CMO. Results: As circulation and respiratory function gradually improved, the VV-A ECMO equipment was removed on May 1, 2018.The patient was successfully withdrawn from artificial ventilation on May 28, 2018, then discharged from hospital on May 30, 2018. Conclusion: After the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. There were certainly many differences between the two sides when they received the treatment of E-CMO. As the special cardiac structure and circulatory characteristics, an individualized liquid management strategy was necessary and it might be better for them to choose an active cycle support earlier.

SummaryBackgroundThe SARS-CoV-2 B.1.1.7 variant which was first identified in the United Kingdom (U.K.) has increased sharply in numbers worldwide and was reported to be more contagious. On January 17, 2021, a COVID-19 clustered outbreak caused by B.1.1.7 variant occurred in a community in Daxing District, Beijing, China. Three weeks prior, another non-variant (lineage B.1.470) COVID-19 outbreak occurred in Shunyi District, Beijing. This study aimed to investigate the clinical features of B.1.1.7 variant infection.MethodsA prospective cohort study was conducted on COVID-19 cases admitted to Ditan hospital since January 2020. Data of 74 COVID-19 cases from two independent COVID-19 outbreaks in Beijing were extracted as study subjects from a Cloud Database established in Ditan hospital, which included 41 Shunyi cases (Shunyi B.1.470 group) and 33 Daxing cases (Daxing B.1.1.7 group) that have been hospitalized since December 25, 2020 and January 17, 2021, respectively. We conducted a comparison of the clinical characteristics, RT-qPCR results and genomic features between the two groups.FindingsCases from Daxing B.1.1.7 group (15 [45.5%] male; median age, 39 years [range, 30.5, 62.5]) and cases from Shunyi B.1.470 group (25 [61.0%] male; median age, 31 years [range, 27.5, 41.0]) had a statistically significant difference in median age (P =0.014). Seven clinical indicators of Daxing B.1.1.7 group were significantly higher than Shunyi B.1.470 group including patients having fever over 38°C (14/33 [46.43%] in Daxing B.1.1.7 group vs. 9/41 (21.95%) in Shunyi B.1.470 group [P = 0 .015]), C-reactive protein ([CRP, mg/L], 4.30 [2.45, 12.1] vs. 1.80, [0.85, 4.95], [P = 0.005]), Serum amyloid A ([SAA, mg/L], 21.50 [12.50, 50.70] vs. 12.00 [5.20, 26.95], [P = 0.003]), Creatine Kinase ([CK, U/L]), 110.50 [53.15,152.40] vs. 70.40 [54.35,103.05], [P = 0.040]), D-dimer ([DD, mg/L], 0.31 [0.20, 0.48] vs. 0.24 [0.17,0.31], [P = 0.038]), CD4+ T lymphocyte ([CD4+ T, mg/L], [P = 0.003]), and Ground-glass opacity (GGO) in lung (15/33 [45.45%] vs. 5/41 [12.20%], [P =0.001]). After adjusting for the age factor, B.1.1.7 variant infection was the risk factor for CRP (P = 0.045, Odds ratio [OR] 2.791, CI [1.025, 0.8610]), SAA (0.011, 5.031, [1.459, 17.354]), CK (0.034, 4.34, [0.05, 0.91]), CD4+ T (0.029, 3.31, [1.13, 9.71]), and GGO (0.005, 5.418, [1.656, 17.729]) of patients. The median Ct value of RT-qPCR tests of the N-gene target in the Daxing B.1.1.7 group was significantly lower than the Shunyi B.1.470 group (P=0.036). The phylogenetic analysis showed that only 2 amino acid mutations in spike protein were detected in B.1.470 strains while B.1.1.7 strains had 3 deletions and 7 mutations.InterpretationClinical features including a more serious inflammatory response, pneumonia and a possible higher viral load were detected in the cases infected with B.1.1.7 SARS-CoV-2 variant. It could therefore be inferred that the B.1.1.7 variant may have increased pathogenicity.FundingThe study was funded by the National Key Research and Development Program (grant nos.2020YFC0846200 and 2020YFC0848300) and National Natural Science Foundation of China (grant no. 82072295).

Objective:To evaluate the application value of serum amyloid A (SAA) and C-reactive protein (CRP) in the monitoring the status of coronavirus disease 2019 (COVID-19).Methods:The clinical data of COVID-19 patients admitted to the Department of Intensive Medicine and Infection Center of Beijing Ditan Hospital affiliated to Capital Medical University from January 20 to June 29, 2020 were retrospective analyzed, including 147 cases in mild group and 75 cases in severe group. The differences between SAA and CRP at each time point between the two groups and the prediction value for severe COVID-19 were analyzed.Results:The average ages of the severe and mild cases were 57.2±16.8 and 35.9±17.4 years old, respectively and the difference was statistically significant ( P<0.05). The proportions of male cases in severe and mild groups were 62.7% and 48.3%, respectively and the difference was statistically significant ( P<0.05). For underlying diseases, the proportion of patient with diabetes in severe and mild groups were 25.3% and 2.7%, respectively and the difference was statistically significant ( P<0.05); the proportion of patient with hypertension in severe and mild groups were 37.3% and 17.0%, respectively and the difference was statistically significant ( P<0.05). The average hospitalization time in severe and mild groups were 31.5±10.2 days and 24.5±13.8 days, respectively and the difference was statistically significant ( P<0.05). The levels of CRP and SAA at the 0, 3, 7 and 14 days after admission in severe were higher than those in mild group. In ROC analyses of the prediction values, the area under curve (AUC) of CPR at the 0, 3, 7 and 14 days after admission for severe COVID-19 were 0.923, 0.918, 0.945 and 0.776 respectively, while AUCs of SAA at the above time points were 0.807, 0.795, 0.864 and 0.762, respectively. CRP level above 27.85mg/dL at 0 day and 45.25mg/dL at 3 days after admission can predict the occurrence of severe illness in patients. SAA level above 66.0mg/dL at 0 day and 267.35 mg/dL at 3 days after hospitalization can predict the occurrence of severe illness in patients. Conclusions:Regular testing of SAA and CRP would be helpful for the judgment of disease severity and the prediction of disease development and can be applied in clinical practice.

Background: SARS-Coronavirus-2 (SARS-CoV-2), the pathogen of coronavirus disease 2019 (COVID-19), not only infects the respiratory tract, but also other organs. About a third of the inpatients of COVID-19 have neurological symptoms and in vitro experiments revealed that SARS-CoV-2 could infect human neural progenitor cells and brain organoids. However, the traditional test often reports negative owing to the low number of virus in the cerebrospinal fluid. To date, timely diagnosis of central nervous system infection of SARS-CoV-2 remains a challenge. Case presentation: On day 14 of COVID-19, seizures , maxillofacial convulsions, intractable hiccups and significant increase in intracranial pressure developed in a 56-year-old man. The RT-PCR of SARS-CoV-2 was negative. SARS-CoV-2 nucleic acid were detected in cerebrospinal fluid (CSF) by ultrahigh depth sequencing. The patient was successfully treated after 14 days of mechanical ventilation and treatment of pneumonia and neurological dysfunction. Conclusions: This case suggests SARS-CoV-2 can invade the central nervous system and relevant examinations with CSF including ultrahigh depth sequencing of SARS-CoV-2 are needed among COVID-19 patients with neurological dysfunction.

当前对于新型冠状病毒缺乏明确有效的抗病毒药物治疗手段[1].选择具有抗病毒、调节免疫和炎性反应的中医药进行中西医结合治疗,可能是救治重症新冠肺炎、降低病死率的合理策略.笔者将中西医结合成功救治的个案介绍给同道,希望为临床医生提供一定的借鉴和参考.

Abstract Background There is currently a lack of nonspecific laboratory indicators as a quantitative standard to distinguish between the 2019 coronavirus disease (COVID-19) and an influenza A or B virus infection. Thus, the aim of this study was to establish a nomogram to detect COVID-19. Methods A nomogram was established using data collected from 457 patients (181 with COVID-19 and 276 with influenza A or B infection) in China. The nomogram used age, lymphocyte percentage, and monocyte count to differentiate COVID-19 from influenza. Results Our nomogram predicted probabilities of COVID-19 with an area under the receiver operating characteristic curve of 0.913 (95% confidence interval [CI], 0.883–0.937), greater than that of the lymphocyte:monocyte ratio (0.849; 95% CI, 0.812–0.880; P = .0007), lymphocyte percentage (0.808; 95% CI, 0.768–0.843; P < .0001), monocyte count (0.780; 95% CI, 0.739–0.817; P < .0001), or age (0.656; 95% CI, 0.610–0.699; P < .0001). The predicted probability conformed to the real observation outcomes of COVID-19, according to the calibration curves. Conclusions We found that age, lymphocyte percentage, and monocyte count are risk factors for the early-stage prediction of patients infected with the 2019 novel coronavirus. As such, our research provides a useful test for doctors to differentiate COVID-19 from influenza.

新型冠状病毒病仍在全世界范围内肆虐,在治疗这种由病毒引发的疾病的同时,由于预防或治疗同时合并的细菌感染,抗菌药物使用负担明显增加,进一步增加了细菌耐药的威胁.本文简述1例危重型新型冠状病毒肺炎患者的救治过程,以此来探讨新型冠状病毒肺炎患者继发感染的发生率、诊断及规范抗菌药物使用等相关问题.

Background Patients with critical illness due to infection with the 2019 coronavirus disease (COVID-19) show rapid disease progression to acute respiratory failure. The study aimed to screen the most useful predictive factor for critical illness caused by COVID-19. Methods The study prospectively involved 61 patients with COVID-19 infection as a derivation cohort, and 54 patients as a validation cohort. The predictive factor for critical illness was selected using LASSO regression analysis. A nomogram based on non-specific laboratory indicators was built to predict the probability of critical illness. Results The neutrophil-to-lymphocyte ratio (NLR) was identified as an independent risk factor for critical illness in patients with COVID-19 infection. The NLR had an area under receiver operating characteristic of 0.849 (95% confidence interval [CI], 0.707 to 0.991) in the derivation cohort and 0.867 (95% CI 0.747 to 0.944) in the validation cohort, the calibration curves fitted well, and the decision and clinical impact curves showed that the NLR had high standardized net benefit. In addition, the incidence of critical illness was 9.1% (1/11) for patients aged ≥ 50 and having an NLR < 3.13, and 50% (7/14) patients with age ≥ 50 and NLR ≥ 3.13 were predicted to develop critical illness. Based on the risk stratification of NLR according to age, this study has developed a COVID-19 pneumonia management process. Conclusions We found that NLR is a predictive factor for early-stage prediction of patients infected with COVID-19 who are likely to develop critical illness. Patients aged ≥ 50 and having an NLR ≥ 3.13 are predicted to develop critical illness, and they should thus have rapid access to an intensive care unit if necessary.

目的 评价Swansea诊断标准与国内诊断标准对于妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)患者诊断的一致性.方法 回顾性分析首都医科大学附属北京地坛医院2008年1月至2018年1月收治的出院诊断为AFLP患者的资料,使用Swansea诊断标准进行评分.对同期收治的非AFLP妊娠期肝病(包括HELLP综合征、妊娠合并脂肪肝、妊娠期肝内胆汁淤积症、妊娠合并其他肝功能衰竭)患者进行Swansea诊断标准评分,并使用国内诊断标准进行判定.对Swansea诊断标准与国内诊断标准进行Kappa一致性检验,计算Swansea诊断标准的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积.结果 出院诊断为AFLP的患者74例,HELLP综合征14例,妊娠合并脂肪肝87例,妊娠期肝内胆汁淤积症220例,妊娠合并其他肝功能衰竭9例.因74例患者中仅4例进行了肝组织活检,故以Swansea评分≥5分作为判定标准.出院诊断为AFLP的患者中,按照Swansea标准诊断AFLP 68例,非AFLP妊娠期肝病6例.非AFLP妊娠期肝病患者共计330例,按照Swansea标准诊断AFLP 13例,非AFLP妊娠期肝病317例.Swansea诊断与国内诊断标准一致性的Kappa值为0.848,ROC曲线下面积为0.940(95％CI:0.902～0.978).结论 Swansea诊断标准与国内诊断标准诊断AFLP的一致性较好,可在临床中推广应用.

Objective To investigate the treatment of the first case of rift valley fever in China. Methods The clinical data, treatments, prognosis and follow up data of the first case of rift valley fever in China were analyzed, retrospectively. Results This case of rift valley fever critically ill patient was male, 45 years old, living in Angela for 2 years, there were no rift valley fever epidemic. The main clinical manifestations were fever, headache, abdominal muscle pain, progressive reduction in urine output. Laboratory tests suggested severe liver and kidney function damage. On the third day of admission, the rift valley fever virus was reported positive by the Chinese CDC, and other pathogens were negative and rift valley fever was confirmed. After continuous blood purification, liver protection, stable cell membrane and symptomatic support treatment, the urine output was gradually increased, liver and kidney function gradually recovered. Outpatient follow-up for six months, liver and kidney function of the case were normal, and the patient was discharged. Conclusions As a zoonotic disease, the risk of rift valley fever incoming to China is gradually increased. Acute renal failure and acute liver injury are the main manifestations of critical rift valley fever, it could be effectively controlled after treatment.

A case of 60-year-old male patient with chronic hepatitis B was admitted for hepatic dysfunction caused by irregular use of antiviral drugs. He began to restart the antiviral therapy regularly with ETV 0.5 mg QN from July 7, 2016.Since there was no improvement of liver function during the monitoring, the total bilirubin was rising; the maximum value was up to 207.2 μmol/L, and PTA was declining; the minimum value arrived at 53%. Therefore, the dose of ETV was changed to 1 mg QN from July 20. On August 4, the patient began to occur muscle weakness, muscle pain and other uncomfortable symptoms, and the laboratory test showed myoglobin> 1200 ng/ml, the creatine kinase was 41940 U/L, the aspertate aminotransferase was 1171 U/L. Routine urine: pH = 7.00, BLD+++ 300 cell/ml, RBC 36.75 p/HPF, the head CT scan was normal. Entecavir induced rhabdomyolysis was considered. So the dose of entecavir was adjusted to 0.5 mg,and the patient was treated with high dose of hydration, and alkalize urine therapy was used as well. Then the patient's muscle symptoms recovered, and the myoglobin, creatine kinase returned to normal.