Outcomes With Cangrelor Versus Clopidogrel on a Background of Bivalirudin: Insights From the CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI])

ObjectivesThe aim of this study was to examine the efficacy and bleeding outcomes of cangrelor in patients in the CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI]) who underwent percutaneous coronary intervention with bivalirudin.BackgroundCangrelor is a potent intravenous P2Y₁₂ inhibitor with rapid onset and offset. In the CHAMPION PHOENIX, cangrelor compared with clopidogrel significantly reduced 48-h ischemic events including stent thrombosis, without increasing major bleeding. Bivalirudin has demonstrated ischemic outcomes similar to those with heparin plus glycoprotein IIb/IIIa inhibition, with reduced bleeding but increased early stent thrombosis.MethodsIn the modified intent-to-treat population, 2,059 patients (18.8%) received bivalirudin, with 1,014 patients in the cangrelor treatment arm and 1,045 in the clopidogrel treatment arm.ResultsAt 48 h, the primary endpoint of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis was lower with cangrelor versus clopidogrel (48 [4.7%] vs. 70 [6.7%]; odds ratio [OR]: 0.68, p = 0.047). Death was similar in both arms (2 [0.2%] vs. 2 [0.2%]). Myocardial infarction was reduced by cangrelor (37 [3.6%] vs. 59 [5.6%]; OR: 0.63, p = 0.03), as was death/myocardial infarction (39 [3.8%] vs. 61 [5.8%]; OR: 0.65, p = 0.04). Cangrelor was associated with a nonsignificant trend toward less stent thrombosis (7 [0.7%] vs. 15 [1.4%]; OR: 0.48, p = 0.10), which was evident within 2 h after percutaneous coronary intervention (p = 0.057). GUSTO (Global Use of Strategies to Open Occluded Arteries) severe bleeding was similar in both arms (2 of 1,021 [0.2%] vs. 2 of 1,055 [0.2%]) as were other bleeding definitions and transfusions. Efficacy and safety results were consistent in patients with stable angina, non–ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction (p for interaction: 0.62 and 0.29).ConclusionsCangrelor may offer an attractive benefit risk profile when used in combination with bivalirudin.     

榆林市中药材生产前景分析与发展对策研究

中医药是我国人民医疗卫生保健体系的重要组成部分,已引起世界各国医药界的广泛关注。加快发展中药材生产,是今后中药材资源开发利用的方向。对今后一段时间我国中药材生产的前景进行预测,探讨分析榆林具备发展中药材的优势条件,并提出中药材发展的对策措施。     

临床检验人员职业感染的危险因素及其对策探讨

目的：分析可能引起临床检验人员感染的因素,并制定相应的措施进行防护,保证检验人员身心健康安全。方法：对检验科实际工作中的职业感染危险因素进行分析,并提出相应的策略,包括加强感染性疾病预防知识的培训,提高工作人员的危险意识等措施。结果：通过上述的防护措施和制度建立,最大程度的降低了检验人员在日常工作中被感染的几率,保障了他们的身心健康安全。结论：针对可能引起职业感染的潜在危险因素,建立健全各种规章制度,加强相关安全意识的培训,改善工作环境和硬件设施,可以有效的预防临床检验人员的职业感染率。     

妊娠梅毒患者综合健康教育干预效果初探

目的探讨妊娠梅毒患者综合健康教育干预模式的应用,并检验其效果。方法选择2010年5月～2011年3月妊娠梅毒患者253例开展干预,随机分为观察组177例,运用综合健康教育干预模式,包括一对一的诊疗服务、健康教育咨询、发放健康教育处方、性伴通知、随访等干预策略;对照组176例,仅进行发放健康教育处方、常规检查与治疗。观察妊娠梅毒患者的依从性及围生儿先天梅毒的发生率。结果观察组配合规范化治疗及健康教育干预的依从性[97．7％（173／177）]远高于对照组[79．5％（140／176）],差异有高度统计学意义（P〈0．01）;观察组发生先天梅毒的同生儿12例,少于对照组的41例,差异有高度统计学意义（χ2=19．59,P〈0．01）。结论妊娠梅毒患者综合健康教育干预模式的应用可提高妊娠梅毒患的依从性及降低围生儿先天梅毒的发生率,对控制梅毒传播具有重要意义。     

国境口岸化学恐怖事件应对策略与措施的探讨

[目的]完善国境口岸应对化学恐怖突发公共卫生事件的策略与措施。[方法]结合《国际卫生条例（2005年）》和卫生检疫工作实践,对国境卫生检疫机构在应对化学恐怖事件的措施进行探讨。[结果]国际恐怖活动对我国的威胁依然存在,国境卫生检疫机构作为口岸第一道防线,应提高对防制化学恐怖事件的认识,并从完善各项制度和自身建设,加强与相关机构横向联系,加强口岸公共卫生应急技术和能力等方面制定应对措施。[结论]国境卫生检疫机构应勇于面对挑战,切实加强并提高针对化学恐怖活动的防备和应急能力。     

我国应对部分药品短缺的策略初探

目的:为协助药品管理者应对药品短缺的挑战及合理使用短缺药品提供参考。方法:借鉴美国医疗机构药师协会的《药品短缺管理指南》并结合我国实际及我院药品短缺的管理实践,探讨对我国具有可操作性的药品短缺管理策略。结果与结论:建议借鉴美国食品与药品管理局的做法,通过卫生部、国家食品药品监督管理局和国家发改委等政府部门共同协调解决医疗必需药品的短缺问题,并在医疗机构建立应对药品短缺预案,从而减少药品短缺引发的临床安全隐患。     

呼吸内科住院老年患者常见护理问题和对策

目的总结呼吸内科老年患者常见的护理问题,并提出对策。方法分析本科40例60岁以上住院患者的基本情况及疾病情况,对其常见护理问题进行分析。结果呼吸内科40例老年患者的健康问题除了与患病有关外,还与老化过程、心理、环境、社会等因素有关。结论要想给病人提供连续的整体护理,提高病人的满意度,就必须要着眼于患者的生理、心理、文化、精神、环境需求。     

中医药进入国际市场的政策法规壁垒及对策

本文对我国中医药产品和服务进入国际市场过程中所面临的国外中医药管理的政策法规进行了系统分析和整理,总结出我国中医药产品和服务进入国际市场面临的政策法规壁垒现状.对国外中医药政策法规壁垒产生的原因进行深入分析后,指出中西方文化背景差异、中药产品达不到国际质量标准、研发水平以及生产工艺落后、国内法律法规不健全、缺乏反技术性贸易壁垒服务体系等是我国中医药出口遭遇政策法规阻碍的主要原因.最后,提出中医药进入国际市场应对政策法规壁垒的相应策略.     

Differential approach to strategies of segmental stabilisation in postural control

The present paper attempts to clarify the between-subjects variability exhibited in both segmental stabilisation strategies and their subordinated or associated sensory contribution. Previous data have emphasised close relationships between the interindividual variability in both the visual control of posture and the spatial visual perception. In this study, we focused on the possible relationships that might link perceptual visual field dependence–independence and the visual contribution to segmental stabilisation strategies. Visual field dependent (FD) and field independent (FI) subjects were selected on the basis of their extreme score in a static rod and frame test where an estimation of the subjective vertical was required. In the postural test, the subjects stood in the sharpened Romberg position in darkness or under normal or stroboscopic illumination, in front of either a vertical or a tilted frame. Strategies of segmental stabilisation of the head, shoulders and hip in the roll plane were analysed by means of their anchoring index (AI). Our hypothesis was that FD subjects might use mainly visual cues for calibrating not only their spatial perception but also their strategies of segmental stabilisation. In the case of visual cue disturbances, a greater visual dependency to the strategies of segmental stabilisation in FD subjects should be validated by observing more systematic "en bloc" functioning (i.e. negative AI) between two adjacent segments. The main results are the following:1.Strategies of segmental stabilisation differed between both groups and differences were amplified with the deprivation of either total vision and/or static visual cues.2.In the absence of total vision and/or static visual cues, FD subjects have shown an increased efficiency of the hip stabilisation in space strategy and an "en bloc" operation of the shoulder–hip unit (whole trunk). The last "en bloc" operation was extended to the whole head–trunk unit in darkness, associated with a hip stabilisation in space.3.The FI subjects have adopted neither a strategy of segmental stabilisation in space nor on the underlying segment, whatever the body segment considered and the visual condition. Thus, in this group, head, shoulder and hip moved independently from each other during stance control, roughly without taking into account the visual condition.The results, emphasising a differential weighting of sensory input involved in both perceptual and postural control, are discussed in terms of the differential choice and/or ability to select the adequate frame of reference common to both cognitive and motor spatial activities. We assumed that a motor-somesthetics "neglect" or a lack of mastering of these inputs/outputs rather than a mere visual dependence in FD subjects would generate these interindividual differences in both spatial perception and postural balance. This proprioceptive "neglect" is assumed to lead FD subjects to sensory reweighting, whereas proprioceptive dominance would lead FI subjects to a greater ability in selecting the adequate frame of reference in the case of intersensory disturbances. Finally, this study also provides evidence for a new interpretation of the visual field dependence–independence dimension in both spatial perception and postural control. Electronic Publication