Still the best way to minimize these infections is to avoid placement of unnecessary lines and to remove them once the indication is not present anymore.
Still 然而、尽管如此
然而，减少这些感染的最好办法是避免放置不必要的导管，一旦引流指征消失立即拔管。
Routine change of central lines has not proven to reduce infection rates.
常规更换导管还未证明能降低感染率。
Chapter 21 Occult and Obscure Gastrointestinal Bleeding Page 60
occult 神秘的、秘密的、隐蔽的 obscure 黑暗的、模糊的、隐匿的
隐匿性和来源不明性胃肠道出血 第60页
Occult bleeding is defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generally by routine fecal occult blood testing (FOBT) or the presence of iron deficiency anemia. (fecal 排泄物、残渣)
隐匿性出血指的是发现无症状性胃肠道出血，一般通过常规的大便隐血试验（FOBT)或存在着缺铁性贫血。
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts.
(initial 开始的、最初的 evaluation 评价)
来源不明性胃肠出血是指首次上、下消化管内窥镜检查都阴性、原发部位不明的持续或反复性出血。
Both of these entities may be presentations of recurrent or chronic bleeding.
entity 实体、存在、本质 presentation 提出、表现、存在
两者都可能表现为反复的或慢性的出血。
The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic evaluation. 对隐匿性胃肠道出血，应该使用内窥镜进行早期检查。
In the setting of an isolated positive FOBT, colonoscopy is indicated as the first test.
(colonoscopy 结肠镜)
只有单独的大便隐血试验阳性情况下，结肠镜作为首选的检查方法是有适应征的。
The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one of more colonic polyps.(yield 产出、结出、产生)
这些病人结肠镜的结果大约2%是癌症，30%是单发或多发的结肠息肉。
The initial approach to a patient with iron deficiency anemia depends on the presence of symptoms referable to either the upper or lower gastrointestinal tract.
(referable 可认为与...有关的、可参考的)
缺铁性贫血病人的首选检查方法要根据存在的症状跟上消化道还是下消化道相关。
Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have both upper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the first one was positive.
complementary 补充的、互补的 positive 确定的、绝对的、真实的
无论首次上、下消化道内窥镜检查会有何发现，所有病人两个检查都应该做，因为互补的内窥镜检查6%有发现，甚至第一次检查是阳性的。
For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia. (premenopausal 绝经前的)
对绝经前妇女，大便隐血试验阳性需要全面分析，缺铁性贫血也一样。
Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that are identified.
utility 实用、效用、通用
隐匿性出血时，上、下消化道的钡剂造影应用有限，因为它们不能活检或治疗发现的病损。
The evaluation of obscure gastrointestinal bleeding is often frustrating
(frustrating 令人泄气的、令人沮丧的) 隐匿性胃肠道出血的诊断常常令人沮丧。
Angiodysplasia is the most common cause in most recent series.
(Angiodysplasia 血管发育畸形) 血管发育畸形是最近病例报导中最常见的病因。
Initial endoscopic examination should focus on any symptoms reported by the patient.
( focus 聚焦、集中、明确) 初始内窥镜检查要盯住病人诉说的任何症状。
Potential causative agents, such as NSAIDs and aspirin, should be discontinued.
(causative 成为原因的 NSAIDs 非甾体类抗炎镇痛药non-steroidal antiinflammatory drugs)
能成为潜在病因的药物，如非甾体类抗炎镇痛药和阿斯匹林，应该停用。
Disorders associated with bleeding, such as hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), inflammatory bowel disease, or a bleeding diathesis should be considered. (telangiectasia 毛细血管扩张 diathesis 素质)
胃肠紊乱伴出血，像遗传性出血性毛细血管扩张症（Osler-Weber-Rendu综合症)、炎症性肠疾病、或出血性体质应该加以考虑。
A repeat endoscopic evaluation may be appropriate, because approximately one third of cases reveal a cause of bleeding overlooked during the initial endoscopy.
内窥镜重复检查可能是恰当的，因为接近三分之一病例查出了首次内窥镜漏掉的出血原因。
When upper endoscopy and colonoscopy are both unrevealing, evaluation of the small bowel is indicated. 当上消化道内窥镜和结肠镜均无发现，小肠检查具有指征。
Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a less than 6% yield from small bowel follow-through and a 10 to 21% yield from enteroclysis.
insensitive 感觉迟钝的 follow-through 持久的贯彻，持续 enteroclysis 小肠造影
小肠X线检查是非侵入性的，但相对不灵敏，小肠全片6%不到有发现，小肠造影10～21％有结果。
By comparison, the diagnostic yield of endoscopic enteroscopy of the small bowel in obscure gastrointestinal bleeding is 38 to 75%. (enteroscopy 肠镜检查)
相比较，对来源不明性胃肠道出血小肠内窥镜的诊断结果是38～75%。
Traditional videoendoscopes can evaluate only the proximal small bowel (≤150cm), whereas longer scopes, which are passed though the entire small bowel and then withdrawn while visualizing the mucosa (sonde enteroscopy), are limited in their ability to visualize the entire mucosa and cannot be used to perform diagnostic or therapeutic maneuvers.
proximal 最接近的、近侧的 visualize 使看得见，想像 sonde 探空火箭
传统的电视内窥镜能检查近端小肠 (≤150cm),然而能通过整个小肠边退边看肠粘膜的更长内镜，也不能看到整个肠粘膜，都不能作为常规的诊断或治疗手段。
When endoscopic evaluation does not detect the cause of blood loss, radiographic procedures such as scintigraphy and angiography should be considered. (scintigraphy 闪烁显像)
当内窥镜检查不能发现出血病因，像闪烁造影和血管造影X线手段应该考虑。
Provocative angiography using heparin or thrombolytic agents has been suggested by some authorities, but this approach has the potential risk of precipitating major bleeding.
Provocative 刺激的、挑拔的、气人的 precipitating 使突然发生、促使
虽然使用肝素或溶栓药的刺激性血管造影被某些专家推荐，但这种方法有促发大出血的潜在风险。
In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide simultaneous diagnosis and therapy. (simultaneous 同时发生的、同时存在的)
碰到进行性出血查不到病因，术中肠镜可能同时解决诊断和治疗。
During the procedure, the surgeon plicates the bowel over the endoscope.
(plicate 有褶的;有皱襞的) 在操作中，外科医生把小肠套迭到内窥镜上。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. 当内镜后退时，内镜发现可以决定是外科切除或（保守)治疗。
The yield of this procedure exceeds 70%. 这个措施的结果超过70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy. (long-term 长期的 transfusion 输血)
某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。
A new device for visualizing the entire gastrointestinal mucosa consists of a small camera in an ingestable capsule that transmits images to receivers attached to the patient’s abdomen and mapped to identify the location of the image.
ingestable 能咽下、能吸收 camera 照相机、电视摄像机
一种新的装置能显示全部胃肠粘膜，这种装置由一颗装有小型摄像机能咽下的胶囊组成，它将（数字)影像信号传到附着在病人腹部的接收器，并绘制出图像来识别影像的位置。
The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible.
potentially 潜在的、可能的 inaccessible 达不到的、难接近的
胶囊小肠镜的诊断效率现在还不清楚，但是，这种方法可能可以显示以前难以接近的小肠段肠管。
No therapeutic maneuvers are possible with the device. 这个装置不可能有任何治疗性操作。
Chapter 23 Diabetic Nephropathy Page 67 第二十三章 糖尿病肾病 第67页
End-stage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and mortality, particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States. (nephropathy 肾病)
由糖尿病性肾病所发展的晚期肾病（EARD)是患病和死亡的一个主要原因，特别在1型糖尿病病人中，在美国涉及30~35%的病人。
Although nephropathy is about one half as frequent in type 2 diabetics (partially due to a shortened life expectancy), type 2 diabetes still makes up the vast majority of diabetic patients seeking therapy for ESRD. (expectancy 期望、预期 make up 补足、编造、组成)
尽管在2型糖尿病（特别是影响寿命的)的肾病发生率大约是（1型的)一半，但2型糖尿病仍然是需要晚期肾病治疗的糖尿病病人的绝大多数。
Overall, diabetes is the leading cause of ESRD in the United states, accounting for more than one third of cases. (overall 总体来说 accounting for 说明、证明、对…负责)
总的来说，糖尿病是美国晚期肾病的首要病因，占三分之一以上。
