Tank Fran?aise腕表问世于1996年,是Tank家族的重要成员。它将金属表链与表壳融为一体,开创时代先河,成为Tank家族中独具气质的一代产品。2023年,CARTIER卡地亚推出Tank Fran?aise全新表款,一体式金属设计更加鲜明醒目,它的简约与精致...Tank Fran?aise腕表问世于1996年,是Tank家族的重要成员。它将金属表链与表壳融为一体,开创时代先河,成为Tank家族中独具气质的一代产品。2023年,CARTIER卡地亚推出Tank Fran?aise全新表款,一体式金属设计更加鲜明醒目,它的简约与精致气韵仿佛浑然天成,亦刚亦柔,以经典名作的典雅风范独树一帜。这款腕表继承了Tank腕表隽永优雅的气质和美学风格,彰显与时俱进的独特魅力。同时,全新设计更兼顾美学和人体工学,为腕表的流线型线条注入无穷活力。展开更多
There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery...There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children.These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous priming.The three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration.Furthermore,these three techniques can be used for all the patients,including emergencies and small babies.In every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.展开更多
AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 pati...AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015.RESULTS Thirty-day mortality(3.5% vs 8.7%:OR=0.44,P=0.21) and 1-year mortality(25.7% vs 20.1%,P=0.55) were similar in the S3-THV and the XT-THV groups.The rates of both major vascular complication and paravalvular regurgitation(PVR)>1 were almost 4 times lower in the S3-THV group than the XT-THV group(major vascular complication: 2.8% vs 9.9%,P<0.0001:PVR>1: 2.4% vs 9.7%,P<0.0001).However,the rate of new pacemaker implantation was almost twice as high in the S3-THV group(17.3% vs 9.8%,P=0.03).In the S3 group,independent predictors of new permanent pacemaker were pre-procedural RBBB(OR=4.9:P=0.001),pre-procedural PR duration(OR=1.14,P=0.05) and device lack of coaxiality(OR=1.13:P=0.05) during deployment.CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV.Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.展开更多
Context: Compared with bare metal stents, sirolimus-elut-ing and paclitaxel-eluting stents have been shown to markedly improve angiographic and clinical outcomes after percutaneous coronary revascularization, but thei...Context: Compared with bare metal stents, sirolimus-elut-ing and paclitaxel-eluting stents have been shown to markedly improve angiographic and clinical outcomes after percutaneous coronary revascularization, but their performance in the treatment of de novo coronary lesions has not been compared in a prospective multicenter study. Objective: To compare the safety and efficacy of sirolimus-eluting vs paclitaxel-eluting coronary stents. Design: Prospective, randomized comparative trial(the REALITY trial) conducted between August 2003 and February 2004, with angiographic follow-up at 8 months and clinical follow-up at 12 months. Setting: Ninety hospitals in Europe, Latin America, and Asia. Patients: A total of 1386 patients(mean age, 62.6 years; 73.1% men; 28.0% with diabetes)with angina pectoris and 1 or 2 de novo lesions(2.25-3.00 mm in diameter) in native coronary arteries. Intervention: Patients were randomly assigned in a 1 ∶ 1 ratio to receive a sirolimus-eluting stent(n=701) or a paclitaxel-eluting stent(n=685). Main Outcome Measures: The primary end point was in-lesion binary restenosis(presence of a more than 50% luminal diameter stenosis) at 8 months. Secondary end points included 1-year rates of target lesion and vessel revascularization and a composite end point of cardiac death, Q-wave or non-Q-wave myocardial infarction, coronary artery bypass graft surgery, or repeat target lesion revascularization. Results: In-lesion binary restenosis at 8 months occurred in 86 patients(9.6% ) with a sirolimus-eluting stent vs 95(11.1% ) with a paclitaxel-eluting stent(relative risk [RR], 0.84; 95% confidence interval [CI], 0.61-1.17; P=.31). For sirolimus- vs paclitaxel-eluting stents, respectively, the mean(SD) in-stent late loss was 0.09(0.43) mm vs 0.31(0.44) mm(difference,-0.22 mm; 95% CI,-0.26 to-0.18 mm; P<.001), mean(SD) in-stent diameter stenosis was 23.1% (16.6% ) vs 26.7% (15.8% )(difference,-3.60% ; 95% CI,-5.12% to-2.08% ; P< .001), and the number of major adverse cardiac events at 1 year was 73(10.7% ) vs 76(11.4% )(RR, 0.94; 95% CI, 0.69-1.27; P=.73). Conclusion: In this trial comparing sirolimus- and paclitaxel-eluting coronary stents, there were no differences in the rates of binary restenosis or major adverse cardiac events. Clinical Trial Registration: ClinicalTrials.gov Identifier:展开更多
In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but...In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated.Prevention includes nasal decontamination,skin preparation,antibioprophylaxis and air filtration in the operating theater.The expertise of the surgical team is an additional factor that is difficult to assess precisely.Diagnosis is often very simple,being made on the basis of a septic state with wound modification,while retrosternal puncture and CT scan are rarely useful.Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy.Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined.However,we suggest that a primary sternal closure is the best surgical option for pediatric patients.We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy,which thus decreases physiological and psychological trauma for patients and families.We have demonstrated the ef-ficiency of this technique,which is also cost-effective by decreasing intensive care and hospital stay durations,in a large group of patients.展开更多
OBJECTIVES: The study examined the effect of isovolumic high-volume hemofiltration(HF) alone or combined with mild hypothermia(HT) on survival after out-of-hospital cardiac arrest(OHCA) with initial ventricular fibril...OBJECTIVES: The study examined the effect of isovolumic high-volume hemofiltration(HF) alone or combined with mild hypothermia(HT) on survival after out-of-hospital cardiac arrest(OHCA) with initial ventricular fibrillation or asystole. BACKGROUND: Global inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis. METHODS: Sixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF(200 ml/kg/h over 8 h) or HF+HT(32℃for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point. RESULTS: The six-month survival curves of the three groups were significantly different, with better survival in the HF group(p=0.026) and in the HF+HT group(p=0.018). After adjustment on baseline characteristics of cardiac arrest, HF(with or without HT) was associated with improved survival(logistic regression odds ratio, 4.4; 95%confidence interval[CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29(95%CI, 0.09 to 0.91) in the HF+HT group and 0.21(95%CI, 0.05 to 0.85) in the HF group. CONCLUSIONS: The HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.展开更多
文摘There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children.These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous priming.The three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration.Furthermore,these three techniques can be used for all the patients,including emergencies and small babies.In every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.
文摘AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015.RESULTS Thirty-day mortality(3.5% vs 8.7%:OR=0.44,P=0.21) and 1-year mortality(25.7% vs 20.1%,P=0.55) were similar in the S3-THV and the XT-THV groups.The rates of both major vascular complication and paravalvular regurgitation(PVR)>1 were almost 4 times lower in the S3-THV group than the XT-THV group(major vascular complication: 2.8% vs 9.9%,P<0.0001:PVR>1: 2.4% vs 9.7%,P<0.0001).However,the rate of new pacemaker implantation was almost twice as high in the S3-THV group(17.3% vs 9.8%,P=0.03).In the S3 group,independent predictors of new permanent pacemaker were pre-procedural RBBB(OR=4.9:P=0.001),pre-procedural PR duration(OR=1.14,P=0.05) and device lack of coaxiality(OR=1.13:P=0.05) during deployment.CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV.Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.
文摘Context: Compared with bare metal stents, sirolimus-elut-ing and paclitaxel-eluting stents have been shown to markedly improve angiographic and clinical outcomes after percutaneous coronary revascularization, but their performance in the treatment of de novo coronary lesions has not been compared in a prospective multicenter study. Objective: To compare the safety and efficacy of sirolimus-eluting vs paclitaxel-eluting coronary stents. Design: Prospective, randomized comparative trial(the REALITY trial) conducted between August 2003 and February 2004, with angiographic follow-up at 8 months and clinical follow-up at 12 months. Setting: Ninety hospitals in Europe, Latin America, and Asia. Patients: A total of 1386 patients(mean age, 62.6 years; 73.1% men; 28.0% with diabetes)with angina pectoris and 1 or 2 de novo lesions(2.25-3.00 mm in diameter) in native coronary arteries. Intervention: Patients were randomly assigned in a 1 ∶ 1 ratio to receive a sirolimus-eluting stent(n=701) or a paclitaxel-eluting stent(n=685). Main Outcome Measures: The primary end point was in-lesion binary restenosis(presence of a more than 50% luminal diameter stenosis) at 8 months. Secondary end points included 1-year rates of target lesion and vessel revascularization and a composite end point of cardiac death, Q-wave or non-Q-wave myocardial infarction, coronary artery bypass graft surgery, or repeat target lesion revascularization. Results: In-lesion binary restenosis at 8 months occurred in 86 patients(9.6% ) with a sirolimus-eluting stent vs 95(11.1% ) with a paclitaxel-eluting stent(relative risk [RR], 0.84; 95% confidence interval [CI], 0.61-1.17; P=.31). For sirolimus- vs paclitaxel-eluting stents, respectively, the mean(SD) in-stent late loss was 0.09(0.43) mm vs 0.31(0.44) mm(difference,-0.22 mm; 95% CI,-0.26 to-0.18 mm; P<.001), mean(SD) in-stent diameter stenosis was 23.1% (16.6% ) vs 26.7% (15.8% )(difference,-3.60% ; 95% CI,-5.12% to-2.08% ; P< .001), and the number of major adverse cardiac events at 1 year was 73(10.7% ) vs 76(11.4% )(RR, 0.94; 95% CI, 0.69-1.27; P=.73). Conclusion: In this trial comparing sirolimus- and paclitaxel-eluting coronary stents, there were no differences in the rates of binary restenosis or major adverse cardiac events. Clinical Trial Registration: ClinicalTrials.gov Identifier:
文摘In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated.Prevention includes nasal decontamination,skin preparation,antibioprophylaxis and air filtration in the operating theater.The expertise of the surgical team is an additional factor that is difficult to assess precisely.Diagnosis is often very simple,being made on the basis of a septic state with wound modification,while retrosternal puncture and CT scan are rarely useful.Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy.Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined.However,we suggest that a primary sternal closure is the best surgical option for pediatric patients.We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy,which thus decreases physiological and psychological trauma for patients and families.We have demonstrated the ef-ficiency of this technique,which is also cost-effective by decreasing intensive care and hospital stay durations,in a large group of patients.
文摘OBJECTIVES: The study examined the effect of isovolumic high-volume hemofiltration(HF) alone or combined with mild hypothermia(HT) on survival after out-of-hospital cardiac arrest(OHCA) with initial ventricular fibrillation or asystole. BACKGROUND: Global inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis. METHODS: Sixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF(200 ml/kg/h over 8 h) or HF+HT(32℃for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point. RESULTS: The six-month survival curves of the three groups were significantly different, with better survival in the HF group(p=0.026) and in the HF+HT group(p=0.018). After adjustment on baseline characteristics of cardiac arrest, HF(with or without HT) was associated with improved survival(logistic regression odds ratio, 4.4; 95%confidence interval[CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29(95%CI, 0.09 to 0.91) in the HF+HT group and 0.21(95%CI, 0.05 to 0.85) in the HF group. CONCLUSIONS: The HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.
基金Direction Generale de la Sante and P rogramme Hospitaller de Recherche CliniqueFrench Ministry of Health (AOM98010)+2 种基金Association pour la Recherche surle Cancer(9099)The guarantor accepts full responsibility for the conduct of the studyhad access to t
