2017年 · 第97卷第10期

Helicobacter pylori (Helicobacter pylori, H．pylori) treatment is the most clinical concern of clinicians. In the currentH.pyloriThe rate of resistance to commonly used antibiotics is increasingly high, while the eradication rate is decreasing^[1,2], current research focuses on how to improveH.pyloriThe eradication rate of^[3]。 So how to challengeH.pyloriDrug resistance and explorationH.pyloriNew therapeutic pathways^[4], has become a hot research topic focused on at present.

Secondary medical service institution, a literal translation of English Step Down facility, refers to a medical service institution between a hospital and a family, including acute rehabilitation centers, long-term acute hospitals, skilled nursing centers, Assisted living facilities, boarding homes, home with home health care, etc. Its function is to meet the different rehabilitation needs of patients at all levels after discharge from hospital to before returning home. Doing so allows for a more rational use of medical resources and expenses. A 1-day hospitalization fee in an American hospital can be 3 to 4 weeks in a skilled nursing home. As far as the author knows, in China, most of these rehabilitation processes are completed in hospitals. Due to the lack of a secondary medical care system and other reasons, the bed turnover rate of Chinese hospitals is low, and the average hospital stay is 2 to 3 times that of the United States, which is very uneconomical. In order to improve the utilization rate of hospitals and meet the needs of social aging, we should vigorously develop the secondary medical system.

Based on evidence-based medical evidence and the clinical experience of many domestic cardiac critical care experts, the Chinese Expert Committee on Severe Cardiac Sedation and Analgesia formulated the Chinese Expert Consensus on Severe Cardiac Sedation and Analgesia. The recommendation strength of the consensus consists of recommendation level and evidence level. Recommended Level: Class I: Proven and/or unanimously recognized as valid; Class II: There are contradictions or different views on the evidence of usefulness and validity; Class IIA: The relevant evidence and/or opinions tend to be useful and valid; Class Ⅱb: the relevant evidence and/or opinions are not sufficiently demonstrated to be useful and effective; Class III: Proven and/or consistently recognized as useless and ineffective and may be harmful in some cases, not recommended. Level of evidence: Level of evidence A: Data from multiple randomized clinical trials or meta-analyses; Evidence Level B: Data from a single randomized clinical trial or multiple non-randomized trials; Evidence Level C: Expert consensus and/or small trial results. At present, the expert consensus on sedation and analgesia has been formulated for comprehensive severe disease. Severe cardiac disease has its own special features and should be listed separately. Because the clinical application is very different in different medical institutions, this consensus is formulated as a clinical reference.

Diffuse lung disease (DLD) has always been a large class of difficult diseases in respiratory department. It can be diagnosed clinically by combining clinical manifestations, imaging and other auxiliary examinations, and a small part of it can be diagnosed clearly by bronchoalveolar lavage. However, it is generally necessary to confirm the diagnosis by histopathological examination. Although surgical lung biopsy (SLB) has a high diagnostic rate, it is rarely used in practice because of large trauma and high cost. However, traditional transbronchial clamp biopsy (TBFB) and percutaneous lung biopsy are often difficult to obtain exact pathological diagnosis because of the small tissue mass obtained. At the end of 2015, we took the lead in carrying out transbronchial frozen lung biopsy (TBCB) under rigid bronchoscope (abbreviated as rigid bronchoscope) to diagnose diffuse lung disease and interstitial lung disease in China, and achieved good results^[1]。 However, the requirements of hard lens technology are high, and there are not many units that can develop hard lens technology in China, which limits the popularization and application of TBCB technology. In order to solve this problem, we improved the TBCB technology in combination with the literature, so that it can be completed in the conventional bronchoscopy room only under a soft bronchoscope (referred to as soft bronchoscope for short) without the need of hard lens, and achieved the same satisfactory effect as the operation under hard lens in the operating room, effectively solving the problem of popularization and application of TBCB, which is reported below.

A 35-year-old male was admitted to the Department of Gastroenterology of Bozhou People's Hospital on March 20, 2014 due to "upper abdominal discomfort with yellow urine staining for 1 week". After excluding hepatitis, autoimmune hepatitis and acute pancreatitis, he was transferred to the Department of Endocrinology on March 23, 2014. One week before admission, the patient experienced nausea, upper abdominal discomfort, and obvious yellowing of urine. He went to the gastroenterology department of our hospital and checked his liver function: total bilirubin (TBIL) 120.7 μ mol/L (normal reference value: 3.0~25.0 μ mol/L), direct bilirubin (DBIL) 73.4 μ mol/L (normal reference value: 0~8.0 μ mol/L), alanine aminotransferase (ALT) 466 U/L (normal reference value: 3~40 U/L), aspartate aminotransferase (AST) 316 U/L (normal reference value: 4~40 U/L), alkaline phosphatase (ALP) 256 U/L (normal reference value: 15~150 U/L). He was diagnosed with abnormal liver function and admitted to gastroenterology. Blood test routine: white blood cells 3.83×10⁹/L, neutrophils 1.58×10⁹/L, platelets 133×10⁹/L, kidney function, blood glucose, stool routine, virus four items [hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibody (anti-HCV), human immunodeficiency virus antibody (anti-HIV), Treponema pallidum antibody (anti-TP)], hepatitis screening (hepatitis A, D, E, G virus antibody), autoimmune hepatitis antibody were not abnormal, upper abdominal CT: high gallbladder density, full pancreas, pancreatitis was not excluded. Treatments such as protecting liver, lowering enzymes and raising white blood cells are given. Check thyroid function: free triiodothyronine (FT₃)>30.80 pmol/L (normal reference value: 2.70-6.15 pmol/L), free thyroxine (FT₄)>154.8 pmol/L (normal reference value: 10.45-24.38 pmol/L), total triiodothyronine (TT₃)>12.32 nmol/L (0.99-2.88 nmol/L), total thyroxine (TT₄)>387.0 nmol/L (55.47-171.60 nmol/L), and thyroid stimulating hormone (TSH) 0.015 μ mol/L (normal reference value: 0.38-4.34 μ mol/L). Hematuria amylase was re-examined many times, and pancreatitis was excluded and transferred to the endocrinology department. Follow-up medical history: Three months before admission, the patient had no obvious triggers for feeling fearful of heat, hyperhidrosis, palpitation, irritability, eating more and hunger, and increased frequency of stool, 5-6 times/d. It was soft stool, no pus and blood, and tenesmus was heavy, and the weight lost nearly 20 kg in a short period of time, accompanied by obvious fatigue. Deny recent use of drugs that impair liver function. Past history, personal history, marriage and childbirth history, and family history are not special.

A 71-year-old male was seen for "left lower limb weakness for half a month". Three years ago, he underwent stent placement due to left superficial femoral artery (SFA) occlusion, and recovered well after operation. The patient developed left lower limb weakness without inducement. The left SFA color Doppler ultrasound showed that the stent was occluded, which was considered as in-stent restenosis. The patient underwent SilverHawk plaque rotation treatment. First, left SFA angiography showed left SFA and stent occlusion (FIG. 1A，FIG. 1B), the distal segment of SFA was developed through the collateral circulation, and the guidewire smoothly passed through the stent and entered the distal end of SFA (Figure 1C), rotating the DSA tube to confirm that the guidewire is inside the stent; Then, the stent was repeatedly rotated with the SilverHawk plaque rotating system, and the intrastent plaque rotated smoothly during the operation. After withdrawing from the SilverHawk plaque rotating system, the angiography showed severe stenosis at the upper end of the stent (Figure 1D), and then use a balloon to dilate the stenosis site (FIG. 2A), and severe stenosis of the upper end of the stent was still seen on re-angiography (Figure 2B), the magnification of fluoroscopy shows that the upper end of the stent is seriously damaged, the metal wire of the stent collapses, and accumulates in the shape of a "bird's nest" (Figure 2C，Figure 2D), considering that the stent was damaged during SilverHawk plaque rotation, it was decided to place a covered stent for treatment. However, after balloon expansion, the covered stent delivery system could not pass through the damaged site of the stent at all, considering that it was related to the "bird's nest"-like accumulation of damaged metal wires, so the covered stent treatment was abandoned. Because of the good collateral circulation between the deep femoral artery and the lower SFA, the ischemic symptom of the patient's left lower limb was not serious, so the operation was terminated. After 1 month of follow-up, the patient still had left lower limb weakness, but there was no obvious sign of ischemia.

Skeletal muscle has always been regarded as the main motor organ of human body and the main place of glucose and lipid metabolism. It is an important target organ of nervous system and endocrine system. However, in recent years, skeletal muscle as an endocrine organ has attracted more and more attention. genome-scale of metabolic network model (GSMM) analysis shows that liver is the most metabolically active organ in human body, followed by fat and skeletal muscle, and there are a large number of proteins derived from skeletal muscle in the circulation^[1]。 Recent studies have shown that skeletal muscle can produce a large number of secreted proteins, which function through autocrine, paracrine and endocrine forms, and are crucial in the regulation of various physiological and pathophysiological functions. Cytokines or peptides produced by skeletal muscle cells, subsequently released into the blood circulation, and then exert endocrine or paracrine effects in other cells, tissues or organs are named myokines^[2]。 They not only act on the sugar, fat and protein metabolism of skeletal muscle itself, but also act as messengers for dialogue between skeletal muscle and liver, fat, heart and brain, regulating the overall metabolic status.

inflammatory bowel disease (IBD) is a chronic non-specific inflammatory disease of the intestine, mainly including Crohn's disease (CD) and ulcerative colitis (UC). At present, tumor necrosis factor alpha (TNF-α) is considered to be the most important pro-inflammatory factor in the development of IBD. There are mainly two subtypes: membrane-bound tumor necrosis factor alpha (mTNF-α) and soluble tumor necrosis factor alpha (sTNF-α) released by proteolysis of transmembrane type. Its mRNA and/or protein are expressed in the blood of IBD patients^[1]intestinal mucosa^[2]feces^[3]With intestinal tissue culture fluid^[4]Both were adjusted upward. infliximab (IFX) neutralizes sTNF-α and mTNF-α and prevents the induction of function in TNF-α receptor (TNFR) expressing cells, including T cell activation and proliferation, cytokine and chemokine production by monocytes-macrophages, cell recruitment, angiogenesis and extracellular matrix degradation^[5]。 It has been reported that serum IFX concentration is positively correlated with clinical response in patients with IBD^[6,7,8]IFX concentration in gastrointestinal mucosa was significantly correlated with serum levels^[9]And even considered the intestinal tissue IFX concentration to be part of the blood drug concentration. So, for IBD induction remission therapy, which is more important for histological remission: IFX concentration in blood or IFX concentration in intestinal tissue? For patients with obvious diarrhea, if IFX is lost with feces, will it affect the intestinal tissue concentration or even its efficacy? This article will elaborate on this.

Standardized and unified medical science and technology terms are the basis of medical science and technology information exchange. Medical terms are not standardized and united, which directly affects the accurate expression, collection, use and transmission of medical scientific and technological achievements^[1]。