现场快速检测高敏肌钙蛋白在老年急性心肌梗死早期的临床诊断价值

目的:观察现场快速检测高敏肌钙蛋白I(hs-cTnI)在急诊老年胸痛患者人群中的表达情况,并评价其对急性心肌梗死(AMI)的诊断效能.方法:选择2018年6月-2021年5月期间我院急诊科收治的胸痛疑似急性冠脉综合征(ACS)而行现场快速检测hs-cTnI的315例老年患者作为研究对象,观察hs-cTnI在老年急性胸痛...     

即时床旁超声心动图在诊断急性高危胸痛病人中的应用

目的:总结即时床旁经胸超声心动图(TTE)在急性高危胸痛患者诊断中的应用。方法:回顾性分析2019年3月至2021年5月广东省河源市人民医院诊治的244例急性胸痛患者的临床资料,并分为急性高危胸痛组63例,非急性高危胸痛组181例(对照组),比较TTE的诊断率及其在不同病因胸痛中的检测指标。结果:TTE诊断急性高危胸痛的检出率为90.5%,明显高于心电图(ECG)检出率的69.8%,P<0.05;急性心肌梗死(AMI)、主动脉夹层(AD)患者的左室舒张末容积、左室射血分数(LVEF)及AD患者的升主动脉直径与对照组均有明显差异,肺栓塞(PE)患者的右室舒张末期容积和三尖瓣环收缩期运动幅度(TAPSE)与对照组有明显差异,P均<0.05。结论:即时床旁TTE能及时快速有效辅助诊断常见急性高危胸痛,建议临床推广应用。     

肺结核住院患者营养风险筛查和评估的最佳证据总结

目的 遴选并获取成人肺结核住院患者营养风险筛查和评估的相关证据,并对最佳证据进行总结。方法 计算机检索Cochrane Library、 PubMed、Embase、护理及相关健康领域文献积累索引数据库、中国生物医学文献数据库、万方、中国知网、维普等数据库及医脉通临床指南网、梅斯医学网、欧洲肠内肠外营养学会网、美国肠内肠外营养学会网、美国营养师学会网、中国肠内肠外营养学会网、中国营养师网中有关肺结核患者营养风险筛查和评估的证据,包括指南、专家共识、证据总结、系统评价及诊断性研究。检索时限为建库至2019年2月1日。结果 共纳入8篇文献,其中3篇指南、1篇系统评价和4篇诊断性研究。总结了7条最佳证据。结论 临床上医护人员对接触的肺结核患者应选择合适的营养风险筛查工具和营养评估指标,应用证据时需结合医院特点和临床环境,有针对性地选择证据,建立肺结核患者营养风险筛查和评估制度、工作流程和实践标准。     

急诊胸痛心血管标志物检测专家共识北大核心CSCD

急性胸痛患者常伴有呼吸困难,因其病因和临床表现多样,致命性胸痛危险性高,所以在急诊建立快速、合理、易行的诊疗程序及路径,优化危险分层和预后评估,正确分流并尽早制定治疗决策至关重要。专家组在最新国内外指南/共识的基础上,结合目前国内临床实践,经多学科专家讨论与协商,共同制定了《急诊胸痛心血管标志物检测专家共识》。     

高压氧联合亚低温治疗在急性重度一氧化碳中毒中的应用

急性一氧化碳中毒(acute carbon monoxide poisoning, ACOP)是秋冬季节急诊科最常见的有害气体中毒原因之一[1]。检索ACOP相关的指南和专家共识有:2012年中国的《一氧化碳中毒临床治疗指南》[1,2,3,4]、2016年欧洲的《高压氧治疗临床指征和实践的建议》[5]、2017年美国的《ACOP患者的急诊评估和管理决策》[6]、2021年中国的《CO中毒迟发性脑病诊断与治疗中国专家共识》[7]和2022年中国的《急性一氧化碳中毒诊治专家共识》[8]。     

胸痛中心对患者诊疗的影响

在临床工作中每天都能遇到急性胸痛的患者,因急性胸痛至门诊就诊的患者接近1/3。胸痛的病种多且复杂,大致可分为心源性胸痛和非心源性胸痛。胸痛中心(CPC)的建立对于快速鉴别胸痛类别和尽快再灌注治疗起到了重要的作用。CPC是通过多学科合作,为胸痛患者提供迅速和准确的诊断、危险评估和恰当治疗手段的综合类科室,它可以提高胸痛在早期的诊断和治疗能力,从而减少误诊和漏诊,避免治疗不足或过度治疗,降低病死率,改善临床预后。     

GRACE评分及血清cTnⅠ、NLR、BNP在急诊胸痛患者急诊科危险分层及心血管不良事件预测中的应用

目的：探讨全球急性冠状动脉事件注册评分及血清肌钙蛋白、中性粒细胞/淋巴细胞比值、B型钠尿肽在急诊胸痛患者急诊科危险分层及心血管不良事件（MACE）预测中的应用。方法：选取2019年6月~2021年2月急诊科收治的以胸痛为主诉的124例患者为研究对象,计算所有患者的全球急性冠状动脉事件注册评分,并检测其血清肌钙蛋白、中性粒细胞/淋巴细胞比值、B型钠尿肽水平,随访1个月,根据随访结果将患者分为MACE组（23例）与非MACE组（101例）,采取Logistic回归行多因素分析,再根据ROC曲线评估预测能力。结果：多因素Logistic回归结果显示,血清肌钙蛋白浓度（β=1.467）、中性粒细胞/淋巴细胞比值（β= 1.575）、B型钠尿肽水平（β=1.266）及全球急性冠状动脉事件注册评分（β=1.092）均与MACE风险呈正相关（P＜0.05）。经ROC分析得出血清肌钙蛋白、中性粒细胞/淋巴细胞比值、B型钠尿肽及全球急性冠状动脉事件注册评分均可作为预测MACE的风险因子（P＜0.05）。根据全球急性冠状动脉事件注册评分分为高危组（32例）、中危组（41例）、低危组（51例）,而随访1个月发现高危组、中危组和低危组MACE发生率分别为34.38%、19.51%和7.84%,差异有统计学意义（?字2=13.16,P= 0.001）。结论：全球急性冠状动脉事件注册评分及血清肌钙蛋白、中性粒细胞/淋巴细胞比值、B型钠尿肽能有效评估急性胸痛患者MACE发生风险,且全球急性冠状动脉事件注册评分对于高危MACE具有一定预测意义。     

胸痛的诊断思路

胸痛是临床最常见的症状之一,仅次于腹痛,为内科急症第2位患者就诊主诉,同时也是医生应该高度重视的病症.引起胸痛的原因很多,主要包括胸壁疾病、纵隔疾病、呼吸系统疾病、心血管系统疾病等.不同原因引起的胸痛,其疼痛部位、疼痛持续时间、疼痛性质、疼痛缓解方式不同,且胸痛的部位和严重程度并不一定和病变的部位和严重程度相一致,故在临床实践中应熟悉胸痛的诊断及鉴别诊断,避免误诊及漏诊.之所以这样强调,是因为急性胸痛包括了一组致命性的疾病,如急性心肌梗死、主动脉夹层、肺栓塞、气胸等.其特点是:起病急、变化快、死亡率高,其预后与抢救是否及时、正确有着密切的关系.临床上并非所有的胸痛患者都是因冠心病所致,据统计以胸痛到医院就诊者,仅1/3的患者为冠心病所致,其余2/3的患者为其他疾患.因此在诊断心源性胸痛时要与其他非心源性胸痛疾病相鉴别.     

急性胸痛的诊断与处理策略及程序

胸痛或胸部不适是临床上常见的症状之一 ,其临床表现多样而复杂。每一胸痛患者表现各异 ,临床危险性存在较大差别 ,因此 ,胸痛患者的诊断与处理对临床医师仍是一个严峻的挑战。为了更好地识别胸痛的危险性 ,制定胸痛的临床决策以及规范胸痛患者的管理 ,以提高胸痛的诊治效果 ,减少不良事件 ,降低医疗费用 ,欧洲心脏病学会有关专家组成的工作小组公布了胸痛处理的指南。1　胸痛的症状、检查与临床诊断评价分析患者胸痛症状的性质对判断胸痛患者是否高危或是否需进入快速通道有重要意义。不仅要注意一些常见的缺血性胸痛 ,如急性冠状动脉综合…     

ACC/AHA不稳定型心绞痛和非ST段抬高心肌梗死治疗指南(2007年修订版)解读(2)

1 初步评估的特点 2007年欧洲UA/NSTEMI指南(2007年欧洲指南)对初步评估阐述相对较少,主要阐明的是患者就诊后如何进行危险分层.2007年指南比较2002年指南不仅强调对ACS进行危险分层,而且更强调临床对ACS患者的初步识别.     

癌症患者未成年子女心理行为问题的研究进展

随着恶性肿瘤的患病人群越来越年轻化以及晚婚晚孕的大趋势,越来越多的癌症患者不仅需要抗癌还需要照护未成年子女。研究显示,癌症患者未成年子女通常会存在各种生理、心理和行为问题,如焦虑、抑郁、社交恐惧、躯体疼痛、失眠和暴力倾向等,但我国研究者并未重视这一群体。青少年是国家的未来,青少年时期正是性格养成的重要阶段,同样也是心理行为问题出现的高发期。因此,研究癌症患者未成年子女的心理行为问题的成因,并开发符合我国文化背景的理论模型和干预措施至关重要。     

Residual /s/ and /r/ distortions: the perspective of the speaker

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap /[symbol: see text]/, or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.     

Residual /s/ and /r/ distortions: The perspective of the speaker

Abstract

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap , or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.     

The Serology of Rho Variants (Rho)

Eighty-two Rh_o samples were tested with a battery of ten anti-Rh_o sera by the antiglobulin, bromelin and albumen replacement technics. The varying ability of different anti-Rh_o sera to react with Rh_o variant cells was clearly demonstrated. Anti-Rh_o used for the detection of Rh_o variants should be specially selected for this purpose. It is suggested that the Rh_o factor results from a genetically determined absence or abnormality of the primary Rh_o factor, and the serologic reactions characterizing it are dependent on the reactions of the subsidiary factors Rh^A, Rh^B, Rh^C, and Rh^D.     

The Phenotype Rhod: Study of Another Family

A case is described in which an Rh_o-positive Negro woman suffered a transfusion reaction. Her serum was found to contain anti-rh", anti-Fy^a, anti-Jk^b and an antibody resembling anti-Rh_o. A family investigation showed that the propositus and two of her five children belong to the pheno- type Rh_o^d. This evidence gives further support to the theory that the agglutinogen Rh_o^d is determined by a corresponding allelic gene R ^od.     

Comparative Absorption of Ferri-Haemoglobin-59Fe/Ferro-Haemoglobin-59Fe and 59Fe3+/59Fe2+ in Humans with Normal and Depleted Iron Stores*

Abstract. The intestinal ⁵⁹Fe absorption from ferri- and ferro-haemogIobin-⁵⁹Fe and ⁵⁹Fe³⁺ and ⁵⁹Fe⁺ was calculated from whole body-⁵⁹Fe-retention measurements in subjects with normal and depleted iron stores. A ferri-haemoglobin-⁵⁹Fe/ferro-haemoglobin-⁵⁹Fe absorption ratio of 1.03 ±0.11 was observed for the absorption of ferri-haemoglobin-⁵⁹Fe (8.6± 0.77%) and ferro-haemogIobin-⁵⁹Fe (8.7±0.94%) in persons with normal iron stores. Depletion of iron stores caused a slight but significant higher rise of ferri-haemoglobin-⁵⁹Fe absorption (22 ± 1.7%) than the increase of ferro-haemoglobin-⁵⁹Fe absorption (18 ±0.9%) so that the absorption ratio was 1.24±0.073.—This remarkable iron valence independence of haemoglobin iron absorption is in considerable contrast to the well-established valence dependence of inorganic iron absorption which favours ferrous iron absorption especially with rising iron doses. The ⁵⁹Fe³⁺/⁵⁹Fe²⁺ absorption ratio for a diagnostic 0.56 mg Fe dose increased from 0.43 in subjects with normal iron stores to 0.74 in persons with depleted iron stores, whereas this absorption ratio was augmented only from 0.21 to 0.28 for the therapeutic 50 mg Fe-dose.—The different influence of iron valence on iron absorption from inorganic and haemoglobin iron supports other evidence for the existence of two separate mechanisms for ferrous iron and haem iron absorption in humans.