关于住院医师规范化培训的现状与思考

住院医师规范化培训是毕业后医学教育的重要组成部分,是培养高质量医疗卫生人才的重要手段,大大提高了我国整体医疗水平。近年来,住院医师规范化培训逐渐成熟,但仍存在一些问题。文章就住院医师规范化培训中学员自身问题、教学内容及体制方面等的问题进行初步的讨论,并就问题的解决对策提出理论层面的建议,旨在更好地进行住院医师规范化培训,进一步提高住院医师的医疗水平。     

裙带菜多糖对人外周血单个核细胞的免疫活性作用

目的 观察裙带菜多糖对人外周血单个核细胞(PBMC)增殖、淋巴细胞亚群的影响,探讨其免疫调节机制.方法 采用逐步分离法对裙带菜多糖进行分离与纯化.Ficoll密度梯度离心法分离PBMC,随机分为观察组和对照组,观察组分别加入0.5、5、20、100、500 μg/mL裙带菜多糖,对照组仅加入PBS.采用MTT法分析裙带菜多糖对人PBMC体外增殖作用的影响;用流式细胞术检测淋巴细胞亚群的变化.结果 观察组各浓度PBMC增殖活性明显高于对照组(P均＜0.01),且随着浓度的增加增殖反应明显增强.观察组CD8+及CD16+ CD56+细胞比例较对照组明显增加,并呈浓度依赖性(P均＜0.01).结论 裙带菜多糖可通过刺激人PBMC增殖促进CD8+、NK细胞增殖,从而发挥细胞免疫调节作用.     

Worldwide Experience with the Robotic Navigation System in Catheter Ablation of Atrial Fibrillation: Methodology, Efficacy and Safety

Worldwide Survey on Robotic AF Ablation . Introduction: The Hansen Robotic system has been utilized in ablation procedures for atrial fibrillation (AF). However, because of the lack of tactile feedback and the rigidity of the robotic sheath, this approach could result in higher risk of complications. This worldwide survey reports a multicenter experience on the methodology, efficacy, and safety of the Hansen system in AF ablations. Methods and Results: A questionnaire addressing questions on patient's demographics, procedural parameters, ablation success rate and safety information was sent to all centers where more than 50 robotic AF ablation cases have been performed. From June 2007 to December 2009, 1,728 procedures were performed at 12 centers utilizing the Hansen robotic navigation technology. The overall complication rate was 4.7% and the success rate was 67.1% after 18 ± 4 months of follow‐up. In 5 low volume centers there appeared to be a learning curve of about 50 cases (complication rate 11.2% for the first 50 cases vs 3.7% for the 51–100 cases; P = 0.044) and a trend showing a decrease of complication rate with increasing case volume. However, in the remaining 7 centers no learning curve was present and the complication rate was stable over time (3.7% for the first 50 cases vs 3.6% for the 51st case thereafter; P = 0.942). Conclusion: The Hansen robotic system can be used for AF ablation safely. In low volume centers, there appeared to be a learning curve of the first 50 cases after which the complication rate decreased. With a higher case volume, the success rate increased. (J Cardiovasc Electrophysiol, Vol. 23, pp. 820‐826, August 2012)     

Safety and Effectiveness of Transvenous Lead Extraction in Octogenarians

Transvenous Lead Extraction . Introduction: As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Western countries. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians. Methods and Results: From January 2005 to January 2011, we reviewed data from consecutive patients ≥ 80 years referred to our institutions for transvenous lead extraction because of cardiac device infection or lead malfunction. Clinical characteristics, procedural features, and periprocedural major and minor complications were compared between octogenarians and younger patients. Out of 849 patients undergoing lead extraction in the participating institutions during the study period, 150 (18%) patients were octogenarians (mean age 84 years; range 80–96; 64% males). A significantly higher percentage of octogenarians presented with chronic renal failure (55% vs 26%; P < 0.001), history of malignancy (22% vs 6%; P < 0.001), and chronic obstructive pulmonary disease (46% vs 19%; P < 0.001). Complete lead extraction rates were similar in the 2 age groups (97% in octogenarians vs 96% in patients <80 years; P = 0.39). Periprocedural death occurred in 2 (1.3%) patients ≥80 years and in 5 (0.72%) patients <80 years (P = 0.45 for comparison). No differences in terms of other periprocedural major and minor complications were found between the 2 age groups. Conclusion: Despite presenting with a significantly higher rate of comorbidities, transvenous lead extraction can be performed safely and successfully in octogenarians. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1103‐1108, October 2012)     

Management of bleeding disorders in adults

Development of FVIII inhibitors is currently the most severe and challenging complication of haemophilia A treatment and represents a very large economic burden for a chronic disease. As a result, clinical research is making major efforts to optimize the therapeutic approaches for this condition. In this section we will review some important aspects of the management of haemophilia in adults, including an overview of bleeding in women with von Willebrand disease, an analysis of FVIII consumption in patients with severe haemophilia A, an update of the ongoing RES.I.ST study, long-term prophylaxis and experience from the Pro.Will study, current evidence relating to economic aspects of the treatment of haemophilic patients with inhibitors (based on the PROFIT study), and an overview of musculoskeletal complications in adults with severe bleeding disorders.