g****i
发帖数: 2269 | 1 昨天终于敲定了offer，算是我的圣诞礼物吧。
机会：这样的机会很难得。以前有个女的到我们科临时加班做tech，中午吃饭就跟她聊
了，结果发现她是我们system里的research institute的research coordinator。她最
早以前是tech，后来熟人介绍她去做research coordinator。tech只是她额外的收入。
我跟她说了我的情况，我以前申请了几次，都在hr就被拒了或者说职位被取消了，后来
就放弃了。而且HR的申请上说必须有一年的research 经验，我每次都硬者头皮投，希
望我以前在国内的research经验能算上，但都失败告终。我给她留了我的名字，电话和
work email。她说如果有位置会替我操个心的，还要我email我的resume给她。回家后
想了想，这只是客套话，而且我不想把自己的resume发给一个几乎是素不相识的人。所
以我就没有发。
惊喜：上个星期突然收到她的email说有个位置，看我是否感兴趣，并给我她的manager
的联系方式。我当天立即send resume。
center简介和面试：第二天manager就打电话... 阅读全帖 |
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y*****g
发帖数: 193 | 2 Our unit just converts into a neuroscience unit. We have cerebral/spinal
stroke pts, and neurosurgery pts like SDH, SAH, IPH, post coiling or post
stent, post brain tumor resection,agniogram,ect... We deal with same
problems as other surgical/medical pts. Not much difference if you treat pt
systemically. |
|
r********1
发帖数: 451 | 3 请教版内的各位大师能人们
本人45岁，39岁发现子宫肌瘤，当时5cm。因为当时刚做完剖腹产，不想再做手术，所
以保守治疗。吃了一段时间低剂量避孕药，月经正常后没有再吃。肌瘤慢慢长大。3年
前7cm。仍然不想手术。这两年长的比较快，夜尿频繁，于是决定手术。决定切除肌瘤
，但是如果有任何异常就子宫全切。今年8月3日做的手术。结果腹腔打开，医生发现肌
瘤非常大，整个子宫就露了一个小头，其他部分包括宫颈都在肌瘤下面。糟糕的是输尿
管因肌瘤压迫distorted. 妇科医生叫来了肿瘤医生，也叫了urologist， 但是
urologist在做手术，所以没来。妇科医生和肿瘤医生商量后决定一定要urologist在场
才切除子宫，所以把腹腔缝合了。妇科医生告诉我他以前从来没有遇到过这样的情况的
。医生告诉我下次手术时urologist要insert stents 进输尿管，为了避免损伤输尿管
。对了，肌瘤是良性的。
我的问题是这种情况是不是一定要urologist在场？这个妇科医生的决定是正确的吗？
因为白挨了一刀，心里不大舒服。其实我个人还是觉得我的妇科医生是不错的。但是很
多朋友都说这个应该是... 阅读全帖 |
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v*x
发帖数: 1370 | 4 来自主题: Pharmaceutical版 - Abbott Abbott's problem started when it was 忽悠'ed by Amgen right before AMGN took
off...considered that Abbott is kind of half-parent company of AMGN. Then
years later it was 忽悠'ed by an as***le Harvard CSO. He canceled most of
the program funding and bought a German company just for gambling. The
whole plan backfired and the company wasted a generation of R&D brainpower.
Abbott bet on another buzz word topic: stent...another miscalculation.
This company has gone downhill for years and it is hard to |
|
v*x
发帖数: 1370 | 5 ok,接着88，HUMIRA你知道是谁主张搞的，花了多大功夫，
ABT上个五年的时间就几乎就是都在填HUMIRA这个黑洞
所以一有机会就把当年搞来HUMIRA的人都给赶走了
还顺道逼走了一个石达开，也就是现在那个HOSPIRA
从CEO老鼠坏特到各级主管对外都跟祥林嫂似的念叨:
“俺们才是懂ABBOTT BUSINESS的人”
为什么丫，不就是给外来的和尚给搞怕了吗
麻省那个BIOSCIENCE中心是跟着HUMIRA过来的，
一直就和本部不对付，当然德国人就更讨厌了
麻省那边也就把着个HUMIRA不放手，
却没开发出什么新药，HUMIRA本身的挖潜也没搞起来
基本上是鸡肋部门了，还“好多人RELOCATE到MA”，你没做梦吧
眼看著就只能靠一个HUMIRA撑著，一个STENT在HYPE，
ABT是严重缺钱，不然它著急把DIAGNOSIS部门卖给GE干什么 |
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R*j
发帖数: 248 | 6 不是大牛，也能说两句吗？
drug delivery的覆盖范围更大点，包括传统的formulation和其他一些现代的技术，比
如prodrug。其实像osmotic pump, needless syringe，drug-coated coronary stent
这种东西也可以叫drug delivery.
现在没人特意抠这个字眼。 |
|
m*******s
发帖数: 469 | 7 本人生统小硕，有两年clinical trials工作经验，现拿到4个offer：
1。JNJ：不过是做drug eluting stent的研发，虽然也是做clinical trials，但是和
做药不太一样，感觉前途比较窄，本来就没几家公司做这个，一旦进了这个行以后想换
药厂就比较难了，顶多只能去medical device公司。
2。GSK：是non-clinical statistician，当时也不知道怎么就申请了，跟clinical
trials完全没关系，主要是和一帮生产线上的chemical engineers，microbiologists
等打交道，提供一些统计support以提高生产效率，保证产品质量，类似consultant的
干活，觉得挺难做的，前途也不光明，让我从clinical转成non-clinical，有点像
career suicide。
3。Covance：senior biostatistician，就是帮药厂做project的，基本全是做药物开
发，主要是Phase II, III，除了干活累点，感觉对今后的career发展最有用，能积累
很多 |
|
r********r
发帖数: 352 | 8 To prevent heart attack or stroke, take one 81mg aspirin each day.
If you have high cholesterol, take a statin drug, zocor, crestor, lipitor,
etc, they are available in China.
no recent MI, no stent, you do not need Plavix, Effient or Brillianta
low dose Rivaroxaban is currently under investigation for patient with
history of acute coronary syndrome to improve cardiovascular outcomes.
The link you posted is not a drug on the US market, I wouldn't trust that. |
|
w********y
发帖数: 35 | 9 warfarin主要针对 clot formation （fibrin rich 的clot 以及静脉血栓）. 主要用
于prevention of stroke in patients with A-fib，or treatment VTE.
antiplatelets such as aspirin 用来防止 platelet rich thrombus formation. 所
以主要用于心脑血管病的防治。机理不一样，所以针对也有不同。
warfarin bleeding risk 远大于aspirin。特别是不能做到有效 routine therapeutic
monitoring 的情况下。
There are situations when a patient will need aspirin, plavix, and warfarin
(比如history of ischemic stroke due to afib, and recent MI with drug eluding stent placement)
There are new antithromboti... 阅读全帖 |
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l******k
发帖数: 27533 | 10 er....
楼主的信息可能我理解错了，我觉得他说的是他家人得过MI,heart attack之类的冠状
动脉clot引起的病，所以问化clot的问题
至于warfarin, aspirin and plavix的比较，warfarin的正确dosing是前提
我的推荐也是有临床试验的study的根据的，上课的时候老师带着我们总结了几个study
,然后跟我们分析为什么warfarin是首选的原因。
warfarin的替代性药源源不断上市，但是新药有新药的问题，而且cost是个大问题
所以现在就说新药替代warfarin还太早了点，在这里也就没推荐给LZ了
therapeutic
warfarin
eluding stent placement)
be approved Eliquis. They all showed benefits over warfarin. I think soon
the market share of warfarin will be replaced by these new agents. |
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u*******s
发帖数: 688 | 11 估计说的是drug-eluting stent, 是支架上有一层药物膜，缓慢释放药物。你朋友貌似
说反了。。？ |
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s**********8
发帖数: 25265 | 12 A medical device is a product which is used for medical purposes in patients
, in diagnosis, therapy or surgery[citation needed]. Whereas medicinal
products (also called pharmaceuticals) achieve their principal action by
pharmacological, metabolic or immunological means. Medical devices act by
other means like physical, mechanical, physico-chemical or chemical means.
Medical devices are included in the category: Medical technology.
Medical devices include a wide range of products varying in comp... 阅读全帖 |
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s**********8
发帖数: 25265 | 13 Biocompatibility
From Wikipedia, the free encyclopediaJump to: navigation, search
http://en.wikipedia.org/wiki/Biocompatibility
Biocompatibility is related to the behavior of biomaterials in various
contexts. The term may refer to specific properties of a material without
specifying where or how the material is used (for example, that it elicits
little or no immune response in a given organism, or is able to integrate
with a particular cell type or tissue), or to more empirical clinical
success ... 阅读全帖 |
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a*i
发帖数: 1652 | 14 这个应该是COMBINATORY PRODUCT吧，类似DRUG ELUTING STENT.
胖猫给我们上上课吧。 |
|
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a*i
发帖数: 1652 | 16 Ubiquitous in biomedical device industry
Such as contact lens, drug eluding stent, suture, adhesive, blood bag,
breast implant etc |
|
|
a*i
发帖数: 1652 | 18 Ubiquitous in biomedical device industry
Such as contact lens, drug eluding stent, suture, adhesive, blood bag,
breast implant etc |
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b***p
发帖数: 1398 | 19 Boston scientific vs. Abbott, which is better in stent market? |
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w*********l
发帖数: 5144 | 20 xience and promus all abbott product. promus is the xience that sold by
boston. it's the deal when boston and abbott acquired Guidant in 2006.
bare metal stent now has less than 10% market.
the |
|
b***p
发帖数: 1398 | 21 Boston scientific vs. Abbott, which is better in stent market? |
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w*********l
发帖数: 5144 | 22 xience and promus all abbott product. promus is the xience that sold by
boston. it's the deal when boston and abbott acquired Guidant in 2006.
bare metal stent now has less than 10% market.
the |
|
b***p
发帖数: 1398 | 23 来自主题: MedicalDevice版 - 灌个水 President Bill Clinton received two drug-coated stents, called "Xience,"
made by Abbott Labs |
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b***p
发帖数: 1398 | 24 来自主题: MedicalDevice版 - 灌个水 President Bill Clinton received two drug-coated stents, called "Xience,"
made by Abbott Labs |
|
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s**********8
发帖数: 25265 | 26 not as big as medtronic one. it has the biggest diabetic patients group.
some longitude compression was reported for promus element which will be an
issue. |
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b***p
发帖数: 1398 | 27 What's the product from Medtronic?
why they would not fix this potential issue "longitudinal-compression"
before launch?
an |
|
s**********8
发帖数: 25265 | 28 medtronic's product no problem. resolute?
longitudinal compression is not in scope since only radial strengh is the
concern for this device. so it is not taken care of by all manufacturers.
promus electment was caught in some complicated cases since this product is
soft in the other direction and collapse during multistent procedure. |
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b***p
发帖数: 1398 | 29 IF this issue would incur some level of risk or complication in the future,
another ASTM with minimum longitudinal resistance requirement might be
needed.
I quickly check their design, the low stress resistance against longitudinal
stretching or collapsing seems to be resulted from short segment design and
two helical connectors. With improved flexibility, they might sacrifice
too much strength (both longitudinal and torsional).
Would three-helical-connectors be possible?
is |
|
s**********8
发帖数: 25265 | 30 regulatory agencies should already looked into it.
,
longitudinal
and |
|
s**********8
发帖数: 25265 | 31 应该是激光刻, 然后表面polish. 具体额也不太懂. |
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s**********8
发帖数: 25265 | 32 FDA现在估计开始有这个方面的concern了, 以前的guidance for industry for stent
每有纵向指标, 支架都是管径向, promus element 有把支架压在一起的case. 虽然
有时候可以bail out, 但是风险大大提高, 好像是支架 linker design 的问题.
absorb 是不错, 就是成本高, 太贵, government不会reimburse, sales前景未知.
medtronic denervation 已经走在了前面, 估计很赚钱. |
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a*i
发帖数: 1652 | 33 不知道这一块有什么热点。查了一下百度：
人工心脏瓣膜（Heart Valve Prosthesis）是可植入心脏内代替心脏瓣膜（主动脉瓣、
肺动脉瓣、三尖瓣、二尖瓣），能使血液单向流动，具有天然心脏瓣膜功能的人工器官
。当心脏瓣膜病变严重而不能用瓣膜分离手术或修补手术恢复或改善瓣膜功能时，则须
采用人工心脏瓣膜置换术。换瓣病例主要有风湿性心脏病、先天性心脏病、马凡氏综合
症等。
主要类型：
机械瓣 Mechanical Prosthesis 或 Mechanical Heart Valve
球笼型瓣 Caged Ball Valve
碟型瓣 Disk Valve
单叶倾碟瓣 Tilting Disk Valve
双叶瓣 Bileaflet Valve
组织瓣（生物瓣） Tissue Valve 或 Bioprosthetic Valve
支架生物瓣 Stent Tissue Valve
无支架生物瓣 Stentless Tissue Valve
人体组织瓣 Human Tissue Valve (Homograft,Autograft,Ross Procedure)
动物组织瓣 Ani... 阅读全帖 |
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b*****o
发帖数: 6080 | 34 我给大家看看我当初的经历和想法，看过即忘便可以。
01/31.昨夜是一个irritated病人，只能睡着，一醒着就瞎折腾，要离开医院，VS就非
常不正常。我想给他short bedbath,他就醒了，这下爆炸了，弄的我很没底气。我
preceptor开始就告诉我别她弄醒了，我不小心就。。。反正后来一剂Ativan又让他睡
过去了，我才感觉好一些。3点多钟来一个new admission,因为不熟悉Medtech，又使自
己焦头烂额。非常非常懊丧。
赶紧去睡，呼呼大睡，眼皮撑不开了。突然想起来3K说“在改”，我也每天都“在改”。
02/05. Had a boring night. One patient is passing away, and the other is
actually passing away as well. The only exciting point is to know one needs
to do urine culture, blood culture & sputum culture (intubated) if in high
fever e... 阅读全帖 |
|
b*****o
发帖数: 6080 | 35 我给大家看看我当初的经历和想法，看过即忘便可以。
01/31.昨夜是一个irritated病人，只能睡着，一醒着就瞎折腾，要离开医院，VS就非
常不正常。我想给他short bedbath,他就醒了，这下爆炸了，弄的我很没底气。我
preceptor开始就告诉我别她弄醒了，我不小心就。。。反正后来一剂Ativan又让他睡
过去了，我才感觉好一些。3点多钟来一个new admission,因为不熟悉Medtech，又使自
己焦头烂额。非常非常懊丧。
赶紧去睡，呼呼大睡，眼皮撑不开了。突然想起来3K说“在改”，我也每天都“在改”。
02/05. Had a boring night. One patient is passing away, and the other is
actually passing away as well. The only exciting point is to know one needs
to do urine culture, blood culture & sputum culture (intubated) if in high
fever e... 阅读全帖 |
|
r******h
发帖数: 552 | 36 谢谢指导啊~~~~
我估计是drug eluting stent吧，因为医生原本让他吃那两药1-2年的。只是目前有副
反应（要命的是我还描述不清有多严重，据我妈说腿上有很多瘀斑），而且人也瘦了，
搞不清咋回事啊~~~
生。
need
higher
can |
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R*******t
发帖数: 367 | 37 Do no harm. If he is relatively young and doesn't have symptoms from carotid
and renal stenosis, why putting him through those invasive procedures?
Average arterial stents have 3-year patency of ~75%. PTA has 40-50%.
What he needs at this moment is solving his claudications. Later on he
should adjust his life style, diet, with necessary medications, to lower his
blood lipid and slow down his atherosclerosis. |
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A*******s
发帖数: 9638 | 38 Surgery/stenting for asymptomatic carotid artery stenosis over 70% is still
controversial.
The key is what caused syncope?
Left carotid artery stenosis usually is not the cause of syncope. Basilar
artery stenosis, however, could induce brain stem ischemia and cause vertigo
and syncope. I did not see basilar artery flow direction on the U/S. If retrograde, a
subclavian steal could cause the syncope.
So you may fix the carotid artery stenosis but not the syncope. The patient
has to be informed pri... 阅读全帖 |
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A*******s
发帖数: 9638 | 39 晕厥（syncope）有很多原因， 心源性晕厥是一大原因， 应该首先排除。 其他原因比
较难以确诊， 最常见的是血管神经性晕厥。
颈动脉狭窄可以手术治疗， 问题是该不该手术？ 毕竟手术也有并发症， 而用药也可
以有效， 比方说springstep的强力铁血降脂。 我加一个就是强力铁血抗血小板， 呵呵
我们通常的做法是， 如果颈动脉狭窄>70%, 并且引起症状， 手术或者stenting就应该
考虑，
你母亲的晕厥一般不是因为颈动脉狭窄引起的，这样就让医生和病人陷入两难， 因为
手术可做可不做， 你要是问外科医生， 可能个个都做， 其他非手术医生， 可能会摇
头。 因为现在并没有统一的看法。
有一点是明确的， 手术并不可能防止晕厥复发， 因为他们没有因果关系。
至于血栓脱落， 有没有想到手术时并发症呢？ 我有一个病人， 本来活的好好的， 因
为手术， 一边完全瘫痪了。
我同意springstep的说法， 就是强力铁血的药物治疗同样有效。 |
|
L****n
发帖数: 12932 | 40 表那么激动， 你的神马降脂对全身性系统性的粥样硬化有什么作用还难说呢。 现在到
底什么脂引起粥样硬化还木有定论。 这些七七八八的statin真要管用， 也不会那么多
病人来手术室这里bypass, 那里stenting的了。 |
|
s********p
发帖数: 1319 | 41 大大，我真的激动得很——为了帮你跳这“坑”，我一直忍了两天，差点就忍不住了，
好高兴！！
Statin类药对易损斑块的稳定作用、引起的一场“Statin”的“革命”，我就不罗嗦啦。
Stent正是我干的活，也是我们鄙视心外科大夫的活！
你现在跳不出这“坑”——嘿！嘿！！嘿！！！ |
|
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R*******t
发帖数: 367 | 43 1 you can start with renal ultrasound. The findings would be bilateral hydro
, renal calcs, left renal mass and bladder mass. Good tech may see the left
adrenal lesion but most won't. Then you will still order a CT or MR for
further delineation. Ultrasound doesn't have radiation, but not as accurate
. However, you can see the ureteral jets to the bladder on real time to
evaluate obstruction, which u can't see with CTs
2. Patient needs renal biopsy performed by radiologists, as well as bladder
w... 阅读全帖 |
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b*****l
发帖数: 8603 | 44 原帖链接：
http://bbs.wenxuecity.com/tzlc/477367.html
Doctors' Worst Investments Ever
You might have thought that investors had learned their lesson after losing
money in the technology stock crash, when sizzling Internet companies and
other high-fliers, such as Enron and WorldCom, saw their market value
vaporize. It was easy for investors to get caught up in the hype back then,
and physicians were no exception.
In recent years, however, many physicians have thumbed their noses at Wall
Street, decidi... 阅读全帖 |
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A*******s
发帖数: 9638 | 45 Thanks Daissy, very impressive analysis.
When EBM is against the reality, it is natural to question the evidence. I
agree with you the studies have to be re-designed. But in reality, how many
of us would question these results if no conflicted interest?
I make two examples here: one is the Lexian's kyphoplasty, please see the
link I provided in that thread. Another is cardiac angioplasty or stenting.
But if we believe in EBM, then seroquel for psychosis in PD would be off
label. And if heal... 阅读全帖 |
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c*****n
发帖数: 949 | 46 From your pics, looks like there is a mild defect in the proximal RCA, which
does NOT need stent. I did not see significant defect in the LAD or
circumflex.
Pharmaceutical intervention with ACE inhibitor, BP and rate control are
recommended. This is what your dad getting in China now. Seem appropriate
therapy. |
|
s*******y
发帖数: 46535 | 47 有關種牙的花費，兩顆牙，零零總總算下來大概得10K
我的oral surgeon給了個estimation，雖然知道種牙很貴，還是有些超出預料，請給點
參考意見，或者推薦Virginia附近的oral surgeon
Stage 1: sinus graft to the upper left jaw #13, #14 area
surgical fee: $1835
IV anesthesia: $390
Stage 2: placement of two implants and temporary healing abutments in the up
per jaw #13, #14 areas
surgical fee: $4200
anesthesia: $0 - $390
另外沒有包括在裡面的有：
1. a surgical guide (stent) for use during the implant placement, fees assoc
iated with this will be billed by dentist
2. 拔牙之後放裡面的graft，這一項... 阅读全帖 |
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M****a
发帖数: 577 | 48 来自主题: Medicalpractice版 - 胆囊息肉 感染和大出血，这些是所有手术可能的并发症。一般术前都打抗生素，如果有免疫缺陷
术后接着打。如果没有凝血障碍，医生做过不少类似手术的话，大出血的概率很低。
还有就是胆汁渗漏，2-3%，这个比较烦，可能需要从体表引流，引流管放置几天然后拔
掉，大部分会好。
还有胆管狭窄，这个几率更小，需要在内窥镜下放stent。
胆囊切除术现在基本都是微创手术，不提供微创手术的医院不要去。
息肉 vs 结晶？你的肯定是息肉，不是息肉的就假设是息肉。我们这里在讨论有可能癌
变的病变，better safe than sorry. |
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u***e
发帖数: 611 | 49 His chest pain doesn't sound like typical angina. Stress test is negative,
of course it could be false negative. If no other risk factors, I would
probably just go with medical treatment without cath. If he has multiple
risk factors like diabetes, family hx, smoking, then he probably should be
cathed.
Is it true that pt with a recent stent should avoid flying? this is new to
me. |
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A*******s
发帖数: 9638 | 50 放射科的主意，新放的stent要等几个星期才可以做MRI。
心脏科一直在看她，因为肾功能不好一直没有做造影。第一次造影和放支架是在外州做
的。 |
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