Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent （DES） is safe and effective compared to coronary artery bypass graft surgery （CABG） for unprotected left main...Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent （DES） is safe and effective compared to coronary artery bypass graft surgery （CABG） for unprotected left main coronary artery （ULMCA） disease at long-term follow up （≥3 years）. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction （MI） or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint （FIR = 0.94, 95% CI： 0.86-1.03）. Besides, DES was significantly associated with higher incidence of MI （HR = 1.56, 95% CI： 1.09-2.22） and repeat revascularization （HR = 3.09, 95% CI： 2.33-4.10） compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke （HR = 0.80, 95% CI： 0.67-0.95） for ULMCA lesions with SYNTAX score ≤32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.展开更多
In the network environment, changes of resources structure, information technology and users requirements of standards library cause series of problems such as unobvious effect of services, low efficiency of resource ...In the network environment, changes of resources structure, information technology and users requirements of standards library cause series of problems such as unobvious effect of services, low efficiency of resource utilization, poor innovation ability, etc. And we point out the problems and challenges faced by traditional standards library in the network environment. The standards library must redesign the organization structure and business process radically so that standards library could improve the service model, enhance the service quality and utilization rate of various document resources.展开更多
libraries are universally accepted as the symbols of college and every university invests large sum of money into libraries. According to the criteria in EUCT （Evaluation in Undergraduate Course Teaching）, college l...libraries are universally accepted as the symbols of college and every university invests large sum of money into libraries. According to the criteria in EUCT （Evaluation in Undergraduate Course Teaching）, college libraries should meet certain standards and the cost will be large. Given the current condition that governmental funding is inadequate, we have to control the cost by ourselves. Our solutions to cost control will focus on three aspects： manpower of stuffs, hardware of library and the maintenance of library.展开更多
文摘Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent （DES） is safe and effective compared to coronary artery bypass graft surgery （CABG） for unprotected left main coronary artery （ULMCA） disease at long-term follow up （≥3 years）. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction （MI） or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint （FIR = 0.94, 95% CI： 0.86-1.03）. Besides, DES was significantly associated with higher incidence of MI （HR = 1.56, 95% CI： 1.09-2.22） and repeat revascularization （HR = 3.09, 95% CI： 2.33-4.10） compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke （HR = 0.80, 95% CI： 0.67-0.95） for ULMCA lesions with SYNTAX score ≤32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.
文摘In the network environment, changes of resources structure, information technology and users requirements of standards library cause series of problems such as unobvious effect of services, low efficiency of resource utilization, poor innovation ability, etc. And we point out the problems and challenges faced by traditional standards library in the network environment. The standards library must redesign the organization structure and business process radically so that standards library could improve the service model, enhance the service quality and utilization rate of various document resources.
文摘libraries are universally accepted as the symbols of college and every university invests large sum of money into libraries. According to the criteria in EUCT （Evaluation in Undergraduate Course Teaching）, college libraries should meet certain standards and the cost will be large. Given the current condition that governmental funding is inadequate, we have to control the cost by ourselves. Our solutions to cost control will focus on three aspects： manpower of stuffs, hardware of library and the maintenance of library.
