主辅分离下大型公立医院创新发展运行模式探索

创新作为现代医院发展的支点,是医院科学运营的动力.企业医院主辅分离后,通过观念创新、技术创新、服务创新和整体发展规模的精心规划,在决策方向、经营运作、核心能力、整体规模上的重点把握和持续创新,提升了医院科学发展力、市场适应力和持续创新力,实现了医院的跨跃式发展.     

Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group

Although drug-eluting stents are still the default interventional treatment of coronary artery disease, drug-coated balloons (DCBs) represent a novel alternative therapeutic strategy in certain anatomic conditions. The effect of DCBs is based on the fast and homogenous transfer of antiproliferative drugs into the vessel wall during single balloon inflation by means of a lipophilic matrix without the use of permanent implants. Although their use is established for in-stent restenosis of both bare-metal and drug-eluting stents, recent randomized clinical data demonstrate a good efficacy and safety profile in de novo small-vessel disease and high bleeding risk. In addition, there are other emerging indications (e.g., bifurcation lesions, large-vessel disease, diabetes mellitus, acute coronary syndromes). Because the interaction among the different delivery balloon designs, doses, formulations, and release kinetics of the drugs used is important, there seems to be no “class effect” of DCBs. On the basis of the amount of recently published data, the International DCB Consensus Group provides this update of previous recommendations summarizing the historical background, technical considerations such as choice of device and implantation technique, possible indications, and future perspectives.     

Usefulness of matrix-assisted laser desorption ionisation–time-of-flight mass spectrometry for identifying clinical Trichosporon isolates

Trichosporon spp. have recently emerged as significant human pathogens. Identification of these species is important, both for epidemiological purposes and for therapeutic management, but conventional identification based on biochemical traits is hindered by the lack of updates to the species databases provided by the different commercial systems. In this study, 93 strains, or isolates, belonging to 16 Trichosporon species were subjected to both molecular identification using IGS1 gene sequencing and matrix-assisted laser desorption ionisation–time-of-flight (MALDI–TOF) analysis. Our results confirmed the limits of biochemical systems for identifying Trichosporon species, because only 27 (36%) of the isolates were correctly identified using them. Different protein extraction procedures were evaluated, revealing that incubation for 30 min with 70% formic acid yields the spectra with the highest scores. Among the six different reference spectra databases that were tested, a specific one composed of 18 reference strains plus seven clinical isolates allowed the correct identification of 67 of the 68 clinical isolates (98.5%). Although until recently it has been less widely applied to the basidiomycetous fungi, MALDI–TOF appears to be a valuable tool for identifying clinical Trichosporon isolates at the species level.     

药物洗脱支架联合药物涂层球囊在冠状动脉左主干分叉病变中的应用

目的评价药物洗脱支架(DES)联合药物涂层球囊(DCB)治疗冠状动脉左主干(LM)分叉病变的临床效果。方法回顾性分析2016年7月至2017年7月采用DES联合DCB治疗的8例LM分叉病变患者临床资料。8例患者均接受LM和左前降支病变处DES治疗,左回旋支开口处DCB治疗,其中6例手术在血管内超声导引下进行。术后即刻造影评价病变血管通畅情况,术后6个月随访再狭窄率及6个月内严重临床事件发生率。结果 DES联合DCB治疗LM分叉病变再狭窄率低[LM(8.4±5.3)%,左前降支(18.2±5.0)%,左回旋支(30.5±16.5)%]。术后所有患者未发生严重临床事件。结论 DES联合DCB介入治疗LM分叉病变安全有效。     

血瘀体质调体主药主方的筛选

中医体质学认为,不同的个体体质对某些疾病具有易罹性、倾向性。现代研究表明,血瘀体质的易患疾病涉及冠心病、黄褐斑、子宫肌瘤、肝癌等诸多疾病,改善和调节血瘀体质可起到防治相关疾病的作用。文章提出活血化瘀、调畅血脉为主,益气行血、理气行血、清热凉血、滋阴养血为辅的血瘀体质调体法则,并根据血瘀体质的稳定性和调体的长期性,阐述活血调体主药的适中性与调体辅药的前瞻性筛选原则。进而结合血府逐瘀汤的原方主治,并深入分析其组方结构和加减运用,将血府逐瘀汤移植作为血瘀体质的调理主方,以期对临床血瘀体质的调理起到一定的指导作用。