BACKGROUND: The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system. METHODS: This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China. RESULTS: At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained. CONCLUSION: In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system. TRIAL REGISTRATION ClinicalTrials.gov , NCT03656848.
Humans ; Cost-Benefit Analysis ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Angiography/methods* ; Middle Aged ; Aged ; Coronary Artery Disease/surgery* ; Quality-Adjusted Life Years ; Fractional Flow Reserve, Myocardial/physiology*

Recent studies have demonstrated that superfamily of transforming growth factor-β (TGF-β) plays vital roles in the development of nervous system and neurological diseases.Growth differentiation factor l 0 (GDF 10) is one of the most prominent members of this superfamily.GDF 10 has been shown to participate in tissue formation during cerebellar development and be closely related to the outcomes of neuralgia,ischemic stroke and other neurological diseases.These findings provide novel ideas for research into pathogenesis of nervous system diseases and targets for development of new therapeutic approaches.This article reviews biochemical structure of GDFI0,its downstream signaling pathways,and its roles in cerebellar development,neuralgia and ischemic stroke.Also the possible neurological diseases that may be treated by GDF10 are listed.

Objective To investigate the effect of donepezil on subventricular zone ( SVZ) neuro-genesis related neurotrophic factors after cerebral infarction. Methods Mice were randomly assigned into three groups: vehicle-treated sham group (Sham+vehicle,n=18),vehicle-treated middle cerebral artery oc-clusion (MCAO) group (MCAO + vehicle,n=30) and donepezil-treated MCAO group (MCAO+donepezil, n=30). Middle cerebral artery occlusion( MCAO) was induced by thread-occlusion method. Nissl staining was used to measure the infarct volume and the modified neurological severity score(mNSS) was used to as-sess neurologic function and brain water content was detected to assess brain edema degree. Proliferative cells and neuroblasts were labeled with 5-bromodeoxyuridine ( BrdU) and doublecortin ( DCX). The SVZ BrdU+/DCX+cells were detected by immunofluorescence. The expression of glial cell line-derived neurotro-phic factor (GDNF),brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were detec-ted by Western blot. Results The infarct volume of MCAO + donepezil group ((13. 33±4. 55)%) was sig-nificantly lower than that of MCAO + vehicle group ((31. 33±3. 93)%,t=7. 34,P<0. 05). The neurologic deficits were significantly ameliorated after donepezil treatment,and the brain water content of MCAO + done-pezil group ((71. 82±10. 18)%)was significantly less than that of MCAO + vehicle group ((85. 93± 7. 54)%,F=13. 480,P<0. 05). All differences were statistically significant (P<0. 05). The area of BrdU+/DCX+cells within SVZ of MCAO + vehicle group ((6. 16±1. 79)%) was significantly larger than that of sham + vehicle group ((2. 25±1. 09)%),and was fewer than that of MCAO+donepezil group ((16. 19± 2. 16)%,F=102. 756,P<0. 05). MCAO significantly promoted the expression of GDNF,BDNF and NGF within SVZ compared with sham operation,and donepezil increased these protein levels(F=15. 114,27. 121, 27. 398,P<0. 05). Conclusion Donepezil regulates neurogenesis via increasesing the expression of GDNF, BDNF and NGF within SVZ after cerebral infarction.

Objective To explore different doses of recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolytic therapy for acute cerebral infarction.Methods 130 patients with acute cerebral infarction were as the research subjects selected from May 2014 to May 2015 for rt-PA thrombolytic therapy, who were divided into two groups according to rt-PA thrombolytic agent dose, 65 cases in each group.Evaluated the clinical efficacy of thrombolytic therapy after treatment in accordance within 24 h intracerebral hemorrhage (ICH) , symptomatic intracerebral hemorrhage (SICH) , other bleeding symptoms and for 3 months after treatment the prognosis was good rate, total mortality.For pre-treatment, the degree of defect nerve function after two groups of patients were scored by NIHSS score, correlation analysis between the two groups of clinical efficacy and function of the degree of nerve defect before treatment.Results 3 months after thrombolysis total mortality in the standard dose group was significantly higher than that in the low-dose group (P<0.05) .After treatment, both groups NIHSS scores were significantly lower than before treatment (P<0.05); After treatment, NIHSS score 4-8 points in the proportion of low-dose group was significantly more than that in the standard dose group (P<0.05); NIHSS score 9-16 points, 17-24 points in the proportion of low-dose group were significantly less than that in the standard dose group (P<0.05).NIHSS9-16 points of patients after total mortality three months in the standard-dose group was significantly higher than that in the low-dose group (P<0.05) . Conclusion Different doses of rt-PA thrombolytic therapy in acute cerebral infarction are basically the same, and the degree of neurological deficit does not affect the efficacy, but reduce mortality in patients 3 months after low-dose rt-PA treatment, it is worth widely used in clinical practice.

ObjectiveTo evaluate the clinical value of Young's modulus by supersonic shear wave elastography (SWE) in differential diagnosis of thyroid solid nod1ules.MethodsEighty-three patients with 113 solid nodules were examined by SWE.All the nodules were confirmed by pathology.According to Young's modulus,a receiver operating characteristic (ROC) curve was drawn,and it used to identify the value of optimal operating point for differential diagnosis of thyroid nodules.Results ① The mean of Young's modulus of benign nodules was (23.57 ± 9.35)kPa,which was significantly different from the valve of malignant nodules (43.73 ± 19.82) kPa ( t =6.31,P =0.00).(②) It showed that the optimal operating point of ROC curve as 27.49,with high sensitivity(93.2％),specificity(81.2％) and accuracy (85.8％).The area under ROC curve was 0.91.Conclusions SWE is a newly quantitative technique of ultrasonography,which is helpful to identify and distinguish in the differential diagnosis of thyroid nodules.