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Milan Milojevic Patrick W. Serruys Joseph F. Sabik David E. Kandzari Erick Schampaert Ad J. van Boven Ferenc Horkay Imre Ungi Samer Mansour Adrian P. Banning David P. Taggart Manel Sabaté Anthony H. Gershlick Andrzej Bochenek Jose Pomar Nicholas J. Lembo Nicolas Noiseux John D. Puskas Arie Pieter Kappetein 《Journal of the American College of Cardiology》2019,73(13):1616-1628
Background
The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown.Objectives
In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG.Methods
Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes.Results
The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65).Conclusions
In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) 相似文献2.
Robert J. Williams Carrie A. Leonard Yale D. Belanger Darren R. Christensen Nady el-Guebaly David C. Hodgins Daniel S. McGrath Fiona Nicoll Rhys M.G. Stevens 《Revue canadienne de psychiatrie》2021,66(5):485
Objective:The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002.Method:An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18+).Results:A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant interprovincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan. The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant interprovincial variation in problem gambling rates. The interprovincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling.Conclusions:Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other Western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in large parts of the population. 相似文献
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向飞 《中华医学教育探索杂志》2019,18(3)
以问题为导向的(Problem based learning,PBL)教学法在国内外高等医学教育中应用广泛并进行了不断改良。我们通过建立典型病例的资料库,逐步将病例引导的PBL教学模式应用于烧伤外科的临床见习教学中,强调以学生为中心,充分调动学生的主观能动性,着眼于学生形成正确的临床思维方法和最终分析解决问题的能力,以此来提高烧伤外科见习教学的质量。 相似文献
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Tim Holland 《The Hastings Center report》2023,53(1):50-51
This letter responds to the article “On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case,” by Henri Wijsbek and Thomas Nys, in the September-October 2022 issue of the Hastings Center Report. 相似文献
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Effective Two-Level Domain Decomposition Preconditioners for Elastic Crack Problems Modeled by Extended Finite Element Method 下载免费PDF全文
Xingding Chen & Xiao-Chuan Cai 《Communications In Computational Physics》2020,28(4):1561-1584
In this paper, we propose some effective one- and two-level domain decomposition preconditioners for elastic crack problems modeled by extended finite element method. To construct the preconditioners, the physical domain is decomposed
into the "crack tip" subdomain, which contains all the degrees of freedom (dofs) of the
branch enrichment functions, and the "regular" subdomains, which contain the standard dofs and the dofs of the Heaviside enrichment function. In the one-level additive
Schwarz and restricted additive Schwarz preconditioners, the "crack tip" subproblem
is solved directly and the "regular" subproblems are solved by some inexact solvers,
such as ILU. In the two-level domain decomposition preconditioners, traditional interpolations between the coarse and the fine meshes destroy the good convergence property. Therefore, we propose an unconventional approach in which the coarse mesh
is exactly the same as the fine mesh along the crack line, and adopt the technique of
a non-matching grid interpolation between the fine and the coarse meshes. Numerical experiments demonstrate the effectiveness of the two-level domain decomposition
preconditioners applied to elastic crack problems. 相似文献