简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

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简介：游戏规则：请阅读并理解下面的短文,同时数一数文中发＂de＂音的字有几个。要想得到成功,除了他人的帮助外,更需要自己不断地增强坚定的意志力。有些人之所以失败,就是因为他们没有坚持下去。正确答案：4个。你数对了吗？

简介：BackgroundShort-termhospitalreadmissionsafterpercutaneouscoronaryintervention(PCI)accountforhighermedicalcostsandpoorprognosisofpatientswithcoronaryarterydisease(CAD).However,patientsathighriskforreadmissionarenotyetidentified.MethodsAtotalof1416patientssuccessfullytreatedwithPCIwereincluded.Dataofage,sex,presentationtypeofCAD,cardiacfunction,coexistentdiseases,contrastdose,numbersoflesionsandstentsimplanted,procedurecomplication,out-of-hospitalmedicationwerecollected.Coxregressionmodelwasemployedtoanalyzethemultiplefactorsinfluencingreadmission.Results75.8%ofallreadmissionswereduetoCADandtheaveragereadmissiontimewas422days.UnivariateanalysisandmultivariateCoxregressionmodeleventuallyshowedthatpatientswithanyprocedurecomplicationsand/ormorelesionsinnumberwereathigherriskforreadmissionwhileolderage,smoke,urgentPCIandmorestentsimplantedpreventedthemfromreadmitting.ConclusionThemajorcauseofreadmissionafterPCIisstillCADitself.DuringtheindexhospitalizationofPCI,patientswithmulti-vesseldiseaseneedcarefultreatmentandprocedurecomplicationsshouldbepreventedinordertoextendtheintervalofreadmission.

简介：如今“会打扮”已经不是女人的专属，成为职场上响当当的“好好先生”也要来点会打扮的碎碎念，向榜样看齐，快快学起来!

简介：Theconventionalbypassdesignistoimplantagraftonthestenosedhostarteryallowingbloodtoflowbypassthestenoticartery.However,restenosisisachallengingproblemwhichfinallyresultsinreoperation.Thepurposeofthispaperistoproposeanewbypassgraftdesignofcoronaryarterywithanassistantgraftforthetreatmentofcoronaryarterystenosis.AnadditionalassistantgraftwasemployedinthenewdesigncomparedwiththeconventionalETSanastomosis.Numericalsimulationswereperformedbymeansoffinitevolumemethodusingcomputationalfluiddynamics(CFD)solver.ResultsdemonstratedthatthenewanastomosesmodelprovidedamoresmoothflowatthedistalETSanastomosiswithoutanystagnationpointonanastomoticbedandvortexformationintheheelregion.Oscillatoryshearindex(OSI)andtime-averagedwallshearstressgradient(TAWSSG)atthearterybedofthedistalETSanastomosiswerereduced.Thecoronaryarterybypassgraftwithanassistantgraftisfeasibletoimprovethelocalhemodynamicsanddiminishtheprobabilityofrestenosisinthetreatmentofcoronaryarterystenosis.

简介：BackgroundLargepercutaneouscoronaryintervention(PCI)centershaveshownstatisticallybetterprognosiswithtransradialapproach(TRA)comparedwithtransfemoralapproach(TFA).SowetriedtocomparetheoutcomesbetweenTRAandTFAinonehighvolumePCIcenterinST-segmentelevationmyocardialinfarction(STEMI)patientsundergoingprimaryPCI.MethodSixhundredandsixtytwoSTEMIpatientswhounderwentprimaryPCIwithstentsimplantationwereretrospectivelyincludedfromJune1,2006toApril30,2011inourhospitalandprospectivelyfollowedforoneyear.Theprimaryendpointwasdefinedasin-hospitalnetadverseclinicalevents(NACE)whichincludeddeath,myocardialinfarction(MI),stroke,targetvesselrevascularization(TVR)andmajorbleeding.Thesecondaryendpointwasdefinedas1yearmajoradversecardiovascularevents(MACE)whichincludeddeath,MIandTVR.ResultsTheoccurrenceratesofNACE(8.0%vs.17.0%,P=0.0018),accesssitecomplications(4.0%vs.10.7%P=0.0027)andaccesssite-relatedmajorbleeding(2.4%vs.6.3%,P=0.0254)wereallhigherintheTFAgroupthanintheTRAgroup.Theincidencerateof1yearMACEwassimilarbetweenTRAandTFA(8.5%vs.13.2%,P=0.0932).TheinverseprobabilitiesweightingmatchedmultivariableCoxregressionanalysisshowedTRAwasanindependentpredictoroflowerratesofin-hospitalNACE(HR:0.58,95%CI:0.34-0.99,P=0.0477),in-hospitaldeath(HR:0.31,95%CI:0.10-0.73,P=0.0499)andaccesssitecomplications(HR:0.37,95%CI:0.19-0.73,P=0.0040).ConclusionsTRAshowedgreatefficacyandsafetyforSTEMIpatientsundergoingprimaryPCIinhighvolumePCIcenters.Itshouldberecommendedasroutinepracticeinfuture,andespeciallyinthosepatientswithhighriskofbleeding.

简介：ThetreatmentofprimarygastricdiffuselargeB-celllymphoma(DLBCL)haschangedradicallyoverthelast10–15years,withtheabandonmentofroutinegastrectomyinfavorofmoreconservativetherapies.Low-levelevidencesuggeststhatconsolidationradiotherapycouldbeavoidedinpatientswithlimited-stageDLBCLofthestomachwhoachievecompleteremissionafterrituximab-CHOPcombination.Small,recentprospectivetrialssuggestthatselectedpatientswithlimited-stageHelicobacterpylori(H.pylori)-positiveDLBCLofthestomachandfavorableprognosticfactorscanbemanagedwithantibioticsalone,withexcellentdiseasecontrolandcurerates,keepingchemo-radiotherapyforunresponsivepatients.Thisrecommendationshouldequallyregardpatientswithmucosa-associatedlymphoidtissue-relatedordenovoDLBCL.FuturestudiesshouldbefocusedontheestablishmentofreliablevariablesabletodistinguishthebestcandidatesforexclusivetreatmentwithH.pylorieradicationfromthosewhoneedforconventionalchemo-immunotherapy.

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简介：BackgroundIncreasedserumleveloflipoprotein(a)(Lp(a))isassociatedwithatherosclerosis.WhetherincreasedLp(a)levelisindependentlyassociatedwiththeseverityofcoronaryarterydisease(CAD)isunclear.MethodsSubjectswereenrolledandreceivedcoronaryangiographytoassessthenumberofstenosedcoronaryartery.ThesubjectswithCADweredividedintonon-significant(<50%stenosis),singleandmultivesselstenosis(≥50%stenosis)groups.Parametersofinterestatbaselinewerecollected.StatisticalanalyseswereperformedtoevaluatetherelationshipbetweenLp(a)levelandCADseverity.ResultsTotally745populationswereenrolledanddiagnosedasCAD(n=605)orwithoutCAD(n=140)onthebasisofangiographyexamination.AscomparedtothesubjectswithoutCAD,serumlevelsofLp(a)andCRP,andthepercentagesofsubjectswithsmokingordiabetesweresignificantlyhigherinsubjectswithCAD.Incontrast,serumlevelsofHDL-CandApo-AweresignificantlylowerinsubjectswithCADascomparedtosubjectswithoutCAD.Incomparisonofsubjectswithnon-significantstenosis(serumLp(a)level,170.0±19.7mg/dL),serumLp(a)levelwassignificantlyhigherinsubjectswithsingle(245.5±22.3mg/dL)ormultiplevesselstenoses(265.8±14.0mg/dL).Withmultivariateregressionanalyses,afteradjustedforage,gender,smoking,familyhistoryandhypertension,therewasstillsignificantassociationbetweenserumLp(a)levelandthenumberofcoronaryarterystenosis.Afteradditionaladjustmentfordiabetes,HbA1c,totalcholesterol,LDL-C,Apo-A,uricacidandCRP,Lp(a)remainedstronglyassociatedwithCADseverity.ConclusionSerumLp(a)levelwassignificantlyassociatedwiththeseverityofcoronaryarterystenosis,whichmayaddthevalueoncardiovascularriskevaluation.

简介：新西兰的ALLBLACKS（著名的橄榄球队）的面纱既神秘又风情万种，而怡然的北岛风光和淳朴的南岛风情，则令“长白云之乡”的新西兰又时刻散发着无限的魅力。即便如笔者般，早已三顾“中土世界”，却仍感意犹未尽。

简介：经过八年的设计和缜密的检测程序，这座位于曼哈顿中心的one57高层住宅即将竣工。Christiandeporlzamparc事务所根据当地规范，将建筑设计成不规则的L形，成为纽约最高的住宅。

简介：De-duplicationusingbiometricshasgainedmuchattentionfromresearchcommunitiesasitprovidesauniqueidentityforeachandeveryindividualamongthelargepopulation.De-duplicationistheprocessofremovingtheinstancesofmultipleenrollmentsbythesamepersonusingtheperson’sbiometricdata.Animportantissueinthelarge-scalede-duplicationapplicationsisthespeedofmatchingandtheaccuracyofthematchingbecausethenumberofpersonstobeenrolledrunsintomillions.Thispaperpresentsanefficientmethodtoimprovetheaccuracyoffingerprintde-duplicationinde-centralizedmanner.De-duplicationaccuracydecreasesbecauseofthenoisepresentinthedata,whichwouldcauseimproperslapfingerprintsegmentation.Inthispaper,anattemptismadetoremovethenoisepresentinthedatabyusingbinarizationofslapfingerprintimagesandregionlabelingofdesiredregionswith8-adjacencyneighborhood.Thedistinctfeatureofthistechniqueistoremovethenoisepresentinthedataforanaccurateslapfingerprintsegmentationandimprovethede-duplicationaccuracy.Experimentalresultsdemonstratethatthefingerprintsegmentationrateandde-duplicationaccuracyareimprovedsignificantly.

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简介：BackgroundTheclinicalcharacteristicsofstrokepatientstreatedwithdoubleanti-platelettherapy(DAPT)afterpercutaneouscoronaryintervention(PCI)isnotclear.MethodsIntotal,2675patientsunderwentPCIandDAPTinGuangdongGeneralHospital,and68outofthemwerehospitalizedduetosuspectedstroke,ofwhom23werediagnosedashavingstroke.Dataofthe23strokepatientswerecollectedandtraditionalriskfactorsassociatedwithstrokewereanalyzedretrospectively.ResultsThemeanageofthesepatientswas75.6±8.7years,and20(87.0%)weremales.Notably,19patientswerecomplicatedwithhypertension,7withdiabetesmellitus,7withprevioushistoryofstroke,nonewithatrialfibrillation(AF)orpatentforamenovale(PFO).Specifically,22patientswerediagnosedwithischemicstroke,and1patientwithhemorrhagicstroke.ConclusionStrokeinpatientstreatedwithDAPTafterPCIwascorrelatedwithadvancedage,gender,hypertension,diabetesmellitus,strokehistory.Longtermelectrocardiography(ECG)maybeneededforthediagnosisofAF,whiletrans-esophagealechocardiography(TEE)maybeneededforPFO.

简介：年届不惑，职业旅行者，几年里脚步遍及全国和国外十几个国家，只因为一份执着的“喜欢”，一份追求心灵的自由，把穷旅当做是一种人生乐趣，把这份乐趣发展为职业，把这份职业升华为宝贵经历的人生信条。他，是游笑天，新浪名博主，旅行作家，也是一个不折不扣的驴友。

简介：Thisisafollowofpreviousworkentitled"OneElectronAtominSpecialRelativitywithdeSitterSpaceTimeSymmetry"[Commun.Theor.Phys.57(2012)930].Inthispaper,weconsiderthehigherordercalculationsandcontributionsinthepreviousframeworktosolveoneelectronatomsindeSitterinvariantrelativisticquantummechanics.Thenext-to-leading-ordercalculationsin1/R2-expansionsshowthatthefine-structureconstantαisvariantwithcosmologictimegoingbyinthedeSitterinvariantspecialrelativisticquantummechanicswithstandardFRWcosmologicmodel.

简介：BackgroundIntheHORIZONS-AMI(HarmonizingOutcomeswithRevasculariZatiONandStentsinAcuteMyocardialInfarction)trial,3,602patientsundergoingprimarypercutaneouscoronaryintervention(PCI)forST-segmentelevationmyocardialinfarction(STEMI)treatedwithbivalirudinhadlowerbleedingandmortalityrates,buthigheracutestentthrombosisratescomparedwithheparin+aglycoproteinⅡb/Ⅲainhibitor(GPI).SubsequentchangesinprimaryPCI,includingtheuseofpotentP2Y12inhibitors,frequentradialintervention,andpre-hospitalmedicationadministration,wereincorporatedintotheEUROMAX(EuropeanAmbulanceAcuteCoronarySyndromeAngiography)trial,whichassigned2,218patientstobivalirudinversusheparin±GPIbeforeprimaryPCI.ObjectivesThegoalofthisstudywastoexaminetheoutcomesofproceduralanticoagulationwithbivalirudinversusheparin±GPIforprimaryPCI,giventheevolutioninprimaryPCI.MethodsDatabasesfromHORIZONS-AMIandEUROMAXwerepooledforpatient-levelanalysis.TheBreslow-Daytestevaluatedheterogeneitybetweentrials.ResultsAtotalof5,800patientswererandomizedtobivalirudin(n=2,889)orheparin±GPI(n=2,911).Theradialapproachwasusedin21.3%ofpatients,prasugrel/ticagrelorwasusedin18.1%ofpatients,andGPIwasusedin84.8%ofthecontrolgroup.Bivalirudincomparedwithheparin±GPIresultedinreduced30-dayratesofmajorbleeding(4.2%vs.7.8%;relativerisk[RR]:0.53;95%confidenceinterval[CI]:0.43to0.66;P<0.0001),thrombocytopenia(1.4%vs.2.9%,RR:0.48;95%CI:0.33to0.71;P=0.0002),andcardiacmortality(2.0%vs.2.9%;RR:0.70;95%CI:0.50to0.97;P=0.03),withnonsignificantlydifferentratesofreinfarction,ischemia-drivenrevascularization,stroke,andall-causemortality.Bivalirudinresultedinincreasedacute(<24h)stentthrombosisrates(1.2%vs.0.2%;RR:6.04;95%CI:2.55to14.31;P<0.0001),withnonsignificantlydifferentratesofsubacutestentthrombosis.Compositenetadversec

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简介：一、正时系统组成部件如图1所示。二、拆卸与安装方法1．拆卸方法（1）从车辆上拆下发动机总成。（2）按下列叙述和相关说明拆下如下部件：