Objective To investigate the efficacy and safety of tirofiban in the treatment of aged patients with acute coronary syndrome (ACS) during primary percutaneous coronary intervention (PCI). Methods Two hundred and fifty-six patients with ACS who underwent primary PCI were randomly divided into two groups: tirofiban group (tirofiban + PCI treatment, n= 130) and control group (routine PCI treatment, n = 126). Tirofiban group was further divided into two subgroups according to the age: aged group(age ≥60 years, n= 68) and non-elderly group(age<60 years, n=62). At the end of PCI procedure, angiographic features such as thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frames count and TIMI myocardial perfusion grades (TMPG) were analyzed immediately. The incidence of major adverse cardiac events (MACE) was observed within 36 hours and 30 days after PCI, and the incidence rates of thrombocytopenia and bleeding were assessed. Results There was no significant difference between both the two study groups and the two subgroups in the basic clinical or angiographic characteristics before PCI (all P>0.05). There was no significant difference between two groups in TIMI 3 flow achievement rate in culprit vessels after PCI (93.6% vs. 91.3%, χ~2 = 1.02, P= 0.313). In tirofiban group, corrected TIMI frames count was significantly higher than that in control group (31.6±7.7 vs. 23.8±6.1, t = 2.49, P 0.026), and TMPG 3 achievement rate was also higher (83.1% vs. 67.5% ,χ~2=4.05, P=0.046). The incidence of MACE was significantly lower in tirofiban group than that in control group both within 36 hours and 30 days after procedure(6.9% vs. 19.0%, χ~2= 6.30, P= 0.013; 3.8% vs. 11.90%, χ~2= 5.82,P=0.018, respectively). No statistical difference was found in mild bleeding complications between the two groups (20.2% vs. 15.2%, χ~2 =3.65, P=0.065), but the incidence of mild bleeding was higher in aged group than that in the non-elderly group(25.0% vs. 14.5%,χ~2=4.98, P=0.026), and the incidences of serious bleeding and thrombocytopenia were similar between the two subgroups. Conclusions Intravenous tirofiban infusion is safe in aged ACS patients during primary PCI, and has favorable short-term outcomes compared with routine treatment, although there is a slight risk of mild bleeding.

The metastasis of contralateral adrenal gland and gallbladder following radical nephrectomy is extremely uncommon in clinical practice. We presented one such case. The patient underwent laparoscopic radical right nephrectomy. Postoperative pathology revealed clear cell carcinoma of the right kidney. Five years after operation, CT revealed occupying lesions in the left adrenal gland and gallbladder. Transperitoneal laparoscopic left adrenalectomy and cholecystectomy were performed. Pathological examination showed that the left adrenal tumor and gallbladder tumor were clear cell carcinoma. The patient received targeted therapy and tumor-free survived for 10 months.

In the field of dental aesthetics,digital aesthetic design plays a crucial role in helping dentists to predict treatment outcomes vis-ually,as well as in enhancing the consistency of knowledge and understanding of aesthetic goals between dentists and patients.It serves as the foundation for achieving ideal aesthetic effects.However,there is no clear standard for this digital process currently in China and abroad.Many dentists lack of systematic understanding of how to carry out digital aesthetic design for treatment.To establish standardized processes for dental aesthetic design and to improve the homogeneity of treatment outcomes,Chinese Society of Digital Dental Industry(CSD-DI)convened domestic experts in related field to compile this consensus.This article elaborates on the key aspects of digital aesthetic data collection,integration steps,and the digital aesthetic design process.It also formulates a decision tree for dental aesthetics at macro level and outlines corresponding workflows for various clinical scenarios,serving as a reference for clinicians.