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消化道出血是临床常见病,常因发病较急而又诊断不清危及患者生命.消化道出血诊断和治疗有多种方法,尤其是随着胶囊内镜、双气囊小肠镜的临床普及和应用,消化内镜已成为诊治消化道出血的首选方法.尽管如此,仍有相当一部分患者内镜检查不能明确诊断或不易做相应内镜检查而需要借助其他检查方法,其中不同的影像学检查方法在消化道出血的诊治中扮演了关键角色.我们可以利用不同的影像学方法准确发现消化道出血部位并相应给予精确处置.     

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??Sepsis is the most important cause of morbidity and mortality in the intensive care unit (ICU)??but it lacks specific clinical manifestations.In this article,the author introduced the vaulable biomarkers on sepsis diagnosis,predicting severity and prognosis,and highlighted the direction of sepsis biomarkers research.     

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炎症性肠病是一组病因不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎和克罗恩病.据统计,克罗恩病发病率每年0.7/10万～11.6/10万,患病率为每年34/10万～106/10万,在欧美发病率高,东方国家少见.     

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原发性小血管炎是以血管壁的炎症和纤维素样坏死为病理特征的一组自身免疫性疾病.其中韦格纳肉芽肿病(WG)和显微镜下型多血管炎(MPA)与抗中性粒细胞胞浆抗体(ANCA)密切相关,故又称为ANCA相关系统性血管炎(AASV).     

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预防为主是脑血管病防治的关键,发生了致残性脑梗死后再去解决问题,为时已晚.     

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冠心病介入治疗 (PCI)围术期抗血小板治疗的重要性冠心病病人接受成功PCI后可有效缓解心绞痛 ,改善心功能及生活质量并延长寿命 ,这一结论已被 2 0多年相关临床试验和大量临床实践所证实。但是 ,接受PCI治疗的冠心病病人无论是在围术期还是术后长期 ,发生血栓的危险性均明显增高。据报道术后 2 4h内急性血栓形成发生率为 0 6 % ,4周内亚急性血栓发生率为0 5 %～ 18 0 % ,术后 1年因血栓性疾病导致心肌梗死或死亡的发生率为 15 8%。PCI术后血栓高风险的主要原因是 :(1)急性冠脉综合征 (ACS ,包括急性心肌梗死和不稳定型心绞痛 )病人…     

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??Abstract??Objective To investigate the roles of tumor markers in diagnosis and prognosis assessment of patients with pancreatic carcinoma.Methods We collected 198 cases of pancreatic carcinoma??50 cases of benign pancreatic diseases and 61 cases of normal controls.Radioimmunoassay was used to detect the tumor markers such as CA19-9??CA242??CA125??CA50 and CEA.A total of 120 cases of pancreatic carcinoma were followed up and the factors influencing their prognosis were analyzed.Results The average levels of CA19-9??CA242 and CA125 in pancreatic carcinoma cases were significantly higher than those in the controls and benign pancreatic disease cases (P<0.05).We obtained sensitivities of 80.84%??72.50%??56.67%??56.12% and 45.31% for CA19-9??CA242??CA125??CA50 and CEA??respectively??and specificities of 76.80%??69.32%??72.96 %??65.33% and 57.40% for CA19-9??CA242??CA125??CA50 and CEA??respectively.Combined detection increased the sensitivity but reduced the specificity.The median survival time of the pancreatic cancer patients was 5.5 months.Patients with tumors located at pancreatic body??tail and the whole pancreas had less survival time than those with tumors located at pancreatic head and neck.Patients with higher levels of CA19-9??CA242 and CA125 had less survival time (P<0.05).Cox multivariate proportional hazards model showed that CA19-9 and CA242 were independent prognostic factors (P<0.05).Conclusion Early diagnosis of pancreatic carcinoma depends on serum examinations of tumor marker.Combined detection increases the sensitivity and reduces the specificity of the markers.Patients with tumor located at the pancreatic body??pancreatic tail??and with higher levels of CA19-9??CA242 and CA125 may have less survival time.CA19-9 and CA242 are independent prognostic factors that may help to assess the prognosis of pancreatic carcinoma.     

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??Abstract??Objective To evaluate the value of serum procalcitonin (PCT) in differentiating pathogens in bloodstream infection patients.Methods Data of septic patients with positive blood cultures who received treatment from January 2011 to December 2013 in the ICU of the First Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively.Based on the culture findings??patients were assigned into 3 groups??Gram-positive group(G??+ group)??Gram-negative group (G??- group) and fungal group.The levels of serum PCT and the White Blood Cell (WBC) count were compared among the 3 groups.Results One hundred and forty two patients were enrolled??including 51 cases in the G??+ group (35.9%)??75 cases in the G??- group (52.8%) and 16 cases in the fungal group (11.3%).The level of serum PCT (65.32±49.23)μg/L in G??- group was significantly higher than that of the G??+ group(5.36±4.37)μg/L and that of the fungal group (1.59±1.22)μg/L.However??no significant difference in WBC counts was found in 3 groups (P=0.62).ROC curve was drawn to evaluate the value of the level of serum PCT to distinguish the G??- bacteria from the non-G-bacteria.The area under curve was 0.973 (95%CI was 0.953-0.993).The diagnostic threshold was >17 μg/L with the specificity of 95% and the sensitivity of 84%.We also drew a ROC curve to evaluate the value of the level of serum PCT to distinguish the acinetobacter baumannii from other pathogens.The area under curve was 0.965 (95%CI was 0.941-0.990).PCT for cut off >42 μg/L with the specificity of 92% and the sensitivity of 85%.In addition??the ROC curve was drawn to evaluate the value of the level of serum PCT to distinguish fungi from other pathogens.The area under curve was 0.965 (95%CI was 0.934-0.996).PCT for cut off <2.1 μg/L with the specificity of 82% and the sensitivity of 95%.     

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文章综述了以阿司匹林为代表、临床常用的几种抗血小板药物在卒中防治方面的循证医学证据。在此基础上比较了中国、美国及欧洲关于卒中二级预防抗血小板治疗的指南推荐,并就抗血小板药物临床常见的胃肠道及颅内出血不良反应和临床规范应用策略做了阐述。     

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随着现代电子技术和生物工程学的飞速发展,肺功能仪不断推陈出新。选用肺功能仪,主要从3个方面进行考虑:一是仪器的适用性,是指适合医院自身情况、能真正用于开展业务的仪器。二是仪器的性价比,是指性能优越、计量准确,且价格合理的仪器。三是售后服务与技术支持,是指故障率低且维修服务及时的仪器。肺功能仪的日常维护是仪器可靠性的保障,其中流速/容量校准、检测气体浓度校准等日常仪器校准是重要内容,当仪器已使用多年或疑有测量误差过大时,建议采用标准呼吸模拟器进行质量检测。     

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??Abstract??Objective To assess the liberal SBT safety screen criteria on weaning in intensive care unit.Methods A total of 82 patients to undergo mechanical ventilationwere randomly assigned to group A (by the liberal SBT safety screen criteria??n=42) and group B (by the traditional SBT safety screen criteria??n=80).After patients passed safety screening??SBT was performed.If SBT was completed??the procedures and results were notified to attending doctors.The decision of discontinuing mechanical ventilation or extubation was made by attending doctors.Finally??we compared the ventilator-free days??mechanical ventilation time??duration of ICU stay??28-day mortality??the rates of self-extubation and reintubation.Results Patients screened by the liberal SBT safety screen criteria spent more days breathing without assistance (25 d vs 21 d??P=0.000)??and the mechanical ventilation time (3 d vs 7.5 d??P=0.000)??time of ICU stay (11 d vs 17 d??P=0.001) and the 28-day mortality rate (14.3% vs 35.0%??P=0.029) were all decreased during the 28-day study period as compared with those by the traditional SBT safety screen criteria.The rates of self-extubation (2.4% vs 7.5%??P=0.574) and reintubation (9.5% vs 7.5%??P=1.000) were not significantly different between the two groups.Conclusion The liberal SBT safety screen criterion is superior to the traditional one??so it can be used as a routine screening standard in clinic.