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*

Pulmonary fibrosis is a chronic， progressive and irreversible interstitial lung disease. At present， there is no specific drug for the treatment of pulmonary fibrosis， and many TCM monomers have potential therapeutic value for pulmonary fibrosis， among which flavonoids are the main representative. For example， total flavones of Astragalus memeranaceus and scutellarin can reduce inflammatory cell infiltration， lung injury and extracellular matrix （ECM） deposition by interfering with transforming growth factor-β1/drosophila MAD protein signaling pathway. Total flavonoids of Oxytropis falcata Bunge and salidroside can inhibit lung inflammation by mediating JAK/signal transduction and transcriptional activator signaling pathway， and prevent the epithelial interstitial transition （EMT） process. Quercetin and Ginkgo biloba leaf extract can reduce the apoptosis of macrophages by inhibiting the nuclear factor-κB signaling pathway and play an anti-pulmonary fibrosis role. Urushetin and proanthocyanidins can promote the morphological recovery of myofibroblasts and reduce ECM deposition through the phosphatidylinositol 3-kinase/protein kinase B/mammalian target protein of rapamycin signaling pathway. Naringin and luteolin can inhibit scorch death of macrophage and inflammation response， and improve lung function and lung tissue injury through NOD-like receptor heat protein domain related protein 3 signaling pathway. The ethanol extract of Phyllanthus emblica and calycosin can improve the inflammatory injury and fibrosis of lung tissue by activating the signaling pathway of nuclear transcription factor erythro2-related factor 2/antioxidant response element. Isogliquiritin can inhibit the phenotypic transformation of epithelial cells and reverse EMT progression by inhibiting extracellular signal-regulating kinase signaling pathway. In the future， scholars should consider developing appropriate drug carriers to improve their bioavailability and further study drug targets and pathways， to provide evidence for the development of traditional Chinese medicine monomers of flavonoids into clinical practice.

Objectives:To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI).Methods:A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding.Results:Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( HR 7.28, 95% CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age ( HR 1.04, 95% CI 1.01-1.07, P<0.01), and low levels of ejection fraction ( HR 0.95, 95% CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO ( HR1.67, 95% CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions:Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.

Background Orbital fracture in children has its own characteristics.Choosing the suitable plastic materials is the effective measurement to improve the successful rate of surgery.Absorbable plate filling provides a new material for children with orbital fracture.However,few studies compare the effectivity and safety between absorbable plate filling and conventional filling.Objective The aim of this study was to compare the longterm efficacy and safety between absorbable plate and Medpor implants in the repair of pediatric orbital fracture.Methods Clinical data of 72 eyes of 72 pediatric patients with orbital fracture who received surgicals reconstruction in Beijing Tongren Eye Center from 2008 April to 2014 August were respectively analyzed,including 28 patients with absorbable plates filling and 44 patients with Medpor implants.Demography and preoperative clinical signs were matched between the two groups.Operative procedure was same except the implanted materials.The functional training of extraocular muscle was performed since the second day after surgery in both groups.The imaging findings of the orbit were evaluated by computed tomography (CT) before and after surgery.The patients were followed-up for avarage 12.7 months after operation.The therapeutic effectiveness and safety were compared between the different implants,such as incidence of enophthalmos,extraocular movement impairment and diplopia,and the sensory deficit of skin and complications were documented.Results Extraocular muscle movement improved and diplopia alleviated or disappeared in 92.9％ (26/28) in the absorbable plate group and 90.9％ (40/44) in the Medporgroup,without significant difference between the two groups (P=0.57).The sensory deficit of skin was found in 13 eyes (46.4％) and 20 eyes (45.5％ in the absorbable plate group and Medpor group,respectively,and there was no significant difference between the two groups (P =0.56).CT revealed that the anatomical reconstruction of orbits could be achieved in all patients in both groups without the shifting of implants and extrusion.No enophthalmos and postoperative infection were found in absorbable plate group,however,the residual enophthalmos or late infection was found in I eye for each in the Medpor group.Conclusions Both the absorbable plate and Medpor implants show good results for reconstruction of pediatric orbital fracture.Absorbable plate is an ideal material for pediatric orbital blowout fracture because of fewer postoperative complications.

Objective To approch the characteristic of diagnosis and treatment of optic nerve injury in double wall optic canal.Methods Six patients,with double wall optic canal found by CT,were treated by drug,operation and visual rehabilitation training.The results of CT,vision-evoked potential and visual recovery were analysed.Results In 6 patients,4 were holo-double wall optic canal and 2 were mero-double wall optic canal,4 were found having bone fracture.All the 6 cases were effective to treatment including 3 patients whose vision was over 0.1.Conclusion In double wall optic canal,the degree of optic nerve injury is slight,visual recovery is better by drug,operation and visual rehabilitation training.

Objective To assess the effect of surgical repair of medial orbital wall combined with orbital floor fracture via lower lid subciliary approach. Design Retrospective case series. Participants 18 cases of medial orbital wall combined with orbital floor fracture. Methods All patients underwent the reconstruction of orbital wall via lower lid subciliary approach. The composite hydroxyapatite was implanted into the surface of medial orbital wall and orbital floor after lacriminal cyst was completely dissected and protected during the operation. Orbital axial and coronal CT, three-dimension CT scan have been used in all the cases preoperalively and postoperatively. Preoperative CT was compared with postoperative CT. Main Outcome Measures Clinical symptoms and complications. Results All patients were followed up for 3 to 18 months. The postoperative scar of infracillary skin was not obvious. The composite hydroxyapatite was not rejected and dislocated in all cases postoperatively. No postoperative epiphora was found in either case. Preoperative diplopia and enophthalmos were corrected. Conclusion The treatment of medial orbital wall combined with orbital floor fracture via an isolated lower lid subciliary approach was feasible. But the incision was only used in the treatment of inferior medial orbital wall combined with orbital floor fracture, especially the transition area fracture between the orbital floor and medial orbital wall.

The effects of normothermic or hypothermic cardiopulmonary bypass(CPB)on hemodynamics, plasma levels of endothelin(ET)and atrial natriuetic peptide(ANP)were comparatively studied in dogs with Swan-Ganz catheter technique and radioimmunoassay. The results showed the total peripheral resistance(TPR)during hypothermic CPB was significantly higher than that of the normothermic. Plasm ET levels increased significantly during hypothermic CPB but remained stable during normothermic CPB. Plasma ANP levels almost unchanged during either CPB. Plasma ET level was positively correlated to TPR but ANT level was not. The results suggest that the increased ET levels may be one of the causes of higher TPR during hypothermic CPB;the stable ET levels contributes to the maintenance of cardiovascular function during and after normothermic CPB and the ANP amount secreted beyond the heart has little effect on the plasma level and hemodynamics during CPB.

Objective To Study the characteristics of the high site visual field injury and the LED-VEP after the head trauma for the purpose of the medico-legal appraisals. Methods 11 cases with cortical blindness resulted from the head injury were studied and then compared with 20 cases suffered from optical nerve injuries with respect to the clinical manifestations and characteristics of the visual field injury and LED-VEP. Results As compared with the characteristics of the optical nerve injuries, besides the subjective complain of lowering the visual field, there were not any positive findings in pupil reflex of light and retina examination in case of the high site visual field injuries. The electrical visual field test revealed the homony-mous hemianopia while the internal segment optical nerve injury manifested unilateral visual field defect. 8 out of 11 cases with cortical blindness, occipital cortex were injured and the flash VEP demonstrated the slight prolongation of the latent period of the PI wave of both eyes, while the PI amplitudes were normal. 3 out of 11 cases were suffered from the subcortical injuries and were manifested with the prolongation of the latent period of the PI wave and the amplitude of the PI wave were significantly reduced. Conclusion Bilateral homonymous hemianopia were the characteristics of the high site visual field injury while the abnormal rate of the flash VEP of the high site visual field was quite low. So that, homonymous hemianopia may be helpful for the diagnosis of cortical blindness. At the same time CT scanning and the electroen-cephalography (EEG) also must be considered comprehensively in the medico-legal appraisals.